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Partnership is dead, long live partnerships


The independent contractor status (and the partnership model) has never been fit for purpose. It was never part of the NHS. It effectively died when Ken Clark introduced a contract that specified what the government should expect from their contract with GPs. So since then the intransigence of the profession to adapt to change, to become more responsive while retaining continuity has mean that the ‘Contract’ has become increasingly explicit and detailed. The less willing the profession has been to become patient responsive rather than doctor orientated, the more the contract has tried to enforce it. The consequence has been that in order to cope with rising demand (for same day as well as long term demand) practices are having to be forced to work collaboratively and to make the most of the seven day working week. It is simply not good enough that patients have to wait 3 weeks for an appointment. While continuity is the key to the doctor-patient relationship it is also not possible when most GPs do on average that 5-6 surgeries a week. It is of course inaccurate to say that consultation rates are rising exponentially, but they are rising. This is mainly due to increasing age of the population and complexity of co-morbidities. The way to respond is to argue for more resources and better workforce numbers and skill mix. It also means smaller list sizes, and managing today’s work today. This would allow better access to your own GP and for same day demand to be managed on that day. Because partnerships have been managed for the benefit of the partners (with notable exceptions) the government has had to curtail their insular outlook for the benefit of comprehensive and timely service. The end of professional partnerships ended with the demise of professionalism as Marshall Marinker pointed out in the 1980s. While we remain Contractors, we will do what the contract tells us to do. And we cannot wind back the clock

Posted date

05 Apr 2019

Posted time