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So you need another doctor

Your practice needs another clinician. Should it be a partner, a salaried GP, a nurse or a health care assistant? And how do you find the right person? Dr Stan Shepherd reports

Your practice needs another clinician. Should it be a partner, a salaried GP, a nurse or a health care assistant? And how do you find the right person? Dr Stan Shepherd reports

You need another doctor in your practice, or at least some extra clinical input. How do you decide who to appoint? And how do you get the person you want?

First, decide why you need the new pair of hands. Is it because you need to add clinical sessions, increase patient access, deliver extended hours, replace a retiring partner or increase the resources for strategic management of the practice? Or maybe a combination of these?

Do you need a partner to fulfil the new role, or have you looked at other ways of solving the problem? For example, by appointing salaried GPs, nurses and health care assistants (HCAs)? Partners are the most costly solution, albeit with possible additional benefits.

Whoever you decide to appoint, anyone on your shortlist must offer clinical competence, excellent communication skills and excellent interpersonal skills as a bare minimum.

What else should a new pair of hands bring?

Every practice is different, as is every candidate. You must find the candidate who solves your problem and who suits your practice. Be clear on your needs, but especially on what suits your practice, your values and motivation.

Partner qualities and skills

Let us assume that you have decided on recruiting a partner, although the points raised in the feature apply equally to any new pair of hands.

You obviously want energy, resources, ideas and commitment. General practice goalposts are in constant motion. Partners ought to spot the movement, identify what to do, and contribute skill, energy and effort to make the necessary changes.

Your partner must see general practice as the business it is. The Government wants to transfer care to privately owned providers. General practices are privately owned providers and have no external shareholders to pay – and have 100% of the shareholders delivering the core business services. If company directors work a day at the coal face it is known as enlightened management practice. GPs do it every day for life. But GPs devote themselves to a single buyer, the NHS. Maybe that needs to change. Maybe this is something you should ask your prospective partner.

All partners need to understand the financial position of the practice. Focussing on expenses alone is insufficient, you have to increase income too. Your new partner should help you identify revenue and profit-increasing opportunities.

Whether you like your partners or not you have to get on with them. You cannot check everything they do. You must trust that they pull their weight. You will, of course, always be convinced that you do.

Choosing the right partner

There are currently about 100 applicants for each partnership vacancy. Recruitment will cost the practice time and money. Appointing your registrar or a locum may be fast and cheap but you will miss the full breadth of available candidates.

Too many CVs are awful – poorly presented, badly laid out, misspelt. There are many books on producing CVs, so there is no excuse. Look for hands-on experience outside clinical practice – a previous non-medical jobs, experience as a chair, treasurer or secretary of organisations.

On informal tours do not oversell the practice, just be yourselves. A creative, insightful, intelligent partner will be a creative, insightful, intelligent candidate. Hard questions from a candidate are good questions for a future partner. They may walk away if you can't or won't answer them. Ask yourself, do you want a partner who does not care about these things? If your answer is yes, perhaps it's not a partner that you need.

Give straight answers that demonstrate what you really think. You need to find the right candidate for your practice and lack of honesty guarantees a mismatch.

Interviewing must be equal and fair – the same questions must be asked in the same order by the same people, with everyone scoring all answers. The scores are a guide and need not force your choice. The practice's questions should be about things that are important to you. Let candidates ask about the things that matter to them.

A serious candidate will want to see the practice accounts. Candidates should want to know your values – what you stand for, what sort of practice you want to be, how close are you to that, and what are you doing to get closer. Candidates should want to know what threats and opportunities you see and how you will counter or exploit them.

Candidates should want to know partners' external interests and workload share and may want to see the partnership agreement.

After making your choice

The reference is no substitute for your own judgment. Nobody seeks references from people who are hostile to them. Unless you know the referee, it is only a check on some of the candidate's claims.

Time to parity is variable. Seek legal and LMC advice if you need it. Draw up a new partnership agreement to include your new partner. Include an assessment period, say six or 12 months, within which either party may unilaterally terminate the agreement.

Dr Stan Shepherd is a GP in the east end of London

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