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At the heart of general practice since 1960

Changing the rules of the game

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General practice has become a house of cards. I am constantly hearing about practices handing back their contracts to NHS England, citing recruitment or financial issues, or a combination of both. What is even more shocking is that these are not in locations you’d be sent to for bad behaviour – they are leafy suburbs with relatively affluent surroundings. 

My own home town of Bristol, the gateway to the South-West, has long been an extremely desirable part of the country in which to live and work. It is one of the most competitive areas for GP training places, but even we couldn’t manage to fill them at the last round of recruitment – and the situation is likely to worsen next year. The town has also seen one of the most recent casualties of the falling cards, when partners at the Northville Family Practice handed back their contracts in October. 

Our partnership contracts belong somewhere in quaint Peter and Jane books

So how can we find the glue to stick these cards together so they don’t tumble down one after another?  In spite of the RCGP propaganda that ‘It’s never been a better time to be a GP’, we all know the sad truth. No one wants to be a GP because the pay and conditions suck. And if you are a partner, they suck even more. 

But something else is also deepening the recruitment crisis and it is the domino effect (sorry, another game reference). Partners in small and medium-sized practices, who see the cards falling around them, are petrified of being the ‘last man standing’ and being left with all the practice liabilities. They RLE (retire, locum or emigrate) and this results in a previously functioning practice suddenly becoming destabilised as it is unable to replace partners. 

Our partnership contracts belong somewhere in quaint Peter and Jane books, while all around us we see the rise of APMS contracts, marketisation of the health service and AQP. We are being asked to compete within a corporate business world, yet we are still shackled by the independent contractor rules of 1948. How many accountants or lawyers are personally responsible for their firm’s liabilities if it goes bust?  The answer is that they are all part of a limited liability partnership, or LLP. This has the same structure as a GP partnership but limits liabilities in the same way as a limited company. The reason GPs can’t change to this structure is simple – it does not allow you to hold a GMS contract or be a vehicle for NHS pensions.

Now, I may be naïve about business and corporate matters, but it is baffling to me that our representatives at the RCGP and GPC have not campaigned for this simple rule change, which might just help us to glue the remaining cards in place and even rebuild. 

Yet in this brave new Tory world, the practices that are handing back their contracts will potentially be taken over by companies on an APMS contract with limited liabilities and nothing to lose. And the house of cards will keep falling.

Dr Shaba Nabi is a GP trainer in Bristol

 

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Readers' comments (6)

  • I believe any body holding an NHS contract can now offer the pension (including LLP), but you can't hold GMS with it.

    The game metaphor is fitting - we're all gambling wiht our livelihoods and health.

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  • We have failed as independent contractors. Think of it this way, there are thousands of practices in the UK ,right. Every practice needs At LEAST one great manager, one great GP, one great receptionist and fantastic team work. I am no statistician but having such teams in most practices is like winning the
    £91 000 000 jackpot. In other words, impossible. On the other hand, large GP hubs with satellite surgeries have a statistically much higher chance to develop and maintain such teams.
    As I said earlier, we failed as independent contractors.

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  • The failure is one of a whole system failure.

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  • ICS status hasn't failed, it's been driven to the wall by a perfect storm of austerity, over-regulation and a serious lack of GPs. Even the corporations know they can't make money out of GMS contracts which is why they have now set their eyes on multispecialty community providers (whatever they are), which effectively privatizes us by the back door. We do need limited liability to compete though.

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  • Need to fight back. Action speaks louder than words. www.familydoctorSOS.co.uk and NHS Survival are trying to help.

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  • So sad GPC is so toothless. We are not even comparing like with like. Some practices are paid 100 pounds, others 500 pounds per patient. When the 100 pound practice fails, the Contracts are awarded to Tory cronies at 500 / head.
    We have effectively no leadership at all. That is our problem. Our so called leaders do shout about how bad everything is and how much worse it is going to be, a self evident fact without doing anything. They should ballot for resignation and GPs , like dentists, can charge what is needed to stay viable.

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