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No partnership ‘myth buster’ can escape the truth about funding

Secret Trainee

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My tutorial this week was on GP partnership. It is a topic I had asked for when I started training and we’d just been sent the GP partnership review ‘myth buster’ for trainees, so it tied in nicely. Unfortunately, this was a tutorial that felt like a one-on-one with a bystander, as the other GP trainee barely asked a single question, which is a shame. They did state at the beginning that they had no interest in partnership – although were interested in understanding how things work.

I had a chat with said trainee afterwards; their concern mainly revolved around risk. My view is that you can’t become a partner if you are not comfortable with some risk – no business can be run with zero risk.

Given the profile of some of the people I went to medical school with, I’m not all surprised that there are GPs who don’t want to be partners under any circumstance. That’s fine and everyone is different. If the partnership model is to survive, it’s the people like me – the maybes but not now – who need convincing. There’s a lot of work to be done on that front.

What bothers me about the document on myth busting is that many of the potential benefits described could equally be said of being a salaried GP in a good practice – such as autonomy and continuity of care. Some issues specific to partnership were addressed, like income from drawings, but I thought the whole document would be that specific. Perhaps the authors’ intention was to be broad… or it’s just that positives are in short supply currently.

As a partner, I should be offered pay and conditions to make working eight sessions a week worthwhile

A key personal concern with partnership – assuming the main source of revenue is from a GMS contract – is that the payments are subject to the whims of the government of the day. There’s some protection from a trade union negotiating that contract, but as a junior doctor currently working under a contract I didn’t vote for, that’s little comfort.

Another problem is costs. Right now, indemnity costs appear to do nothing but rise and if a practice wants to recruit and retain staff then it is obliged to meet these. Usually a business can adjust for increased costs by raising prices to the customer, streamlining the goods or services it offers or making changes to payroll costs – for example, reducing hours of work, holding back wage rises or laying off staff surplus to requirements. But in NHS general practice, there are no prices to raise, we can’t cherry-pick the most profitable patients and currently the primary care workforce isn’t growing so the balance of power lies with employees.

Workforce is the key reason I don’t plan on entering a partnership any time soon. Primary care doesn’t have the oligopoly on GPs in the way secondary care does on hospital consultants. As a partner, I should be offered something in pay and conditions to make working eight sessions a week worthwhile. Under the current framework, I can’t see how I could do so and make the liabilities of being a partner worth it.

Secret Trainee is a GP registrar in England

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Readers' comments (11)

  • Spot on poisonous primary care sector at the moment for partners there is reducing rewards for increasing risks.Sit out the storm if you can, alternatively leave for somewhere that appreciates your skill set.This is definitely not the UK at the moment.

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  • You're on the cusp of seeing the bigger picture here, my friend. The current situation is the expected consequence of socialised healthcare provision and state intervention. Don't allow yourself to think salaried GPs or locums will be spared eventually if we don't turn the ship around. The ultimate decision is whether to stay and fight the good fight, or leave the fight to others and run to somewhere less/not affected.

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  • Even in hospital many juniors prefer to locum rather than take a permanent post. In many specialities suitably qualified locums can just name their price per hour due to huge shortages of staff. Extra clinics, such as at the weekend, are also very lucrative and can be just as financially beneficial as private work.

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  • AlanAlmond

    It’s going to take a long long time for things to change. I see nothing to suggest the process has even started, we’re still on the downward swing. The time scales needed are measured in major slices of an individuals career. It might be an interesting intellectual excercise figuring out exactily what is wrong...but people have to plan their lives in the here and now, and maybe project forward to the next 5 or 10 years. Over these time frames doctoring in the UK is a dead and dying duck.

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  • A well run farm will have a lot more sheep than sheep dogs.

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  • A well written and sensible article. I agree with you but in bad times there are opportunities also for drs like you - there are still some higher earning practices in nice places to work eg fully dispensing, research income etc that would be good to join as a partner with little competition currently.

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  • I have always planned my life in 1,5 and 10 years chunks. Yes I am on the Spectrum- Aspergers,
    Right now my plan runs like this
    1 Year - continue GP Locuming in nice Rural Practices only. No urban grunge
    5 years- Go to New Zealand/ Australia .
    10 Years- see if things have improved in UK. If not try Canada.

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  • Christine you'd better adjust your time frame if you're thinking of coming to Australia, there isn't much of a doctor shortage down here any more and in many metro areas there is a surplus..meaning dwindling income as you are paid on a fee for item of service basis. GPs are about to come off the Skilled Occupation List. New Zealand is still short, Canada is now the 'New Australia'- its colder but if you love winter sports you'll be fine! The main issue is that General practice has become crappy everywhere, globally the emphasis is on privatisation and specialisation. Medicine has become an industry to make money for private companies, and public health general practice doesn't fit the vision of the politicians and business people who are calling the shots..... we are no longer our T+Cs to those of specialists..... only the gullible would consider General Practice for a career now.

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  • Spot on @curious!

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  • I woof exactly say it’s gullable to go into GP. There’s far too much work to be done, there will always be the majority of doctoring being done in this country in primary care. We may not be valued as much by politicians but we are valued by the general public (the majority). We need to just adapt what we do to meet the demands of integrated working as that’s filfillig the zeitgeist. It’ll change again soon.

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