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Partnership review? Oh no it isn’t!

Dr Samir Dawlatly

dr sam dawlatly 3

When is a review not actually a review? A review is only meaningful if it results in necessary change. And if the interim report of the Partnership Review, led by Wessex LMCs chief executive Dr Nigel Watson, is anything to go by, then I doubt very much that necessary and meaningful change will happen as a result.

The optimist would say this review is taking place because the RCGP, BMA, Department of Health and NHS England were all concerned about the state of the GP workforce and whether the partnership model is sustainable. The cynic would suggest the review was instigated in response to the report of the House of Lords Committee into NHS Sustainability.

Many GPs wouldn’t have got past their first recommendation, which was to overhaul the GP partnership model as it was deemed no longer fit for purpose. This may or may not have had anything to do with the way senior GPs answered the Committee’s questions about general practice and their vision of its future.

It seems to be an expensive way of saying, ‘Whoops, that’s not what we really meant, we really like you GP partners, really we do’. So the purpose of the review has never been to explore the alternative options around GP partnership, but a way of giving it a morale boost, an injection, or in the words of the interim report, ‘to make recommendations to revitalise the partnership model of general practice’.

I can confidently predict it will conclude that the partnership model needs a bit of tweaking rather than overhauling

Our LMCs are, by and large, ardent supporters and advocates of the partnership model. They exist to support the business of general practice. Not to question Dr Watson’s motives in this, which I am sure are perfectly honourable, but if you want to carry out a review that isn’t going to examine meaningful alternatives to the partnership model, then there can be no better person to appoint to lead that review than an LMC chief executive.

So, I can confidently predict that Dr Watson and his team will hear from plenty of GP partners and ex-GP partners and conclude that the partnership model is a good thing or was a good thing, but needs a bit of tweaking here and there rather than overhauling. It is telling that the key issues highlighted by the interim report are workload, workforce and risk. You’ll note that over-regulation and funding are not listed as primary concerns.

The opportunity to explore what does and doesn’t work in primary care in other health economies will slide by until the next loss of confidence in the model occurs. So, a partnership advocate will complete a partnership review, in which this is the only model he has been asked to look at, and conclude (for that is what he was asked to do) that the partnership model is the only way forward. I’ll eat this blog if it doesn’t.

Dr Samir Dawlatly is a GP partner in Birmingham

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Readers' comments (10)

  • I hear the sound of a can being kicked down a road,one with a dead end.

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  • personally I find it reassuring to hear some support for partnerships which have evolved over the last 60 years as the most efficient and popular way to deliver personal primary care. True they face terrible headwinds particularly over-regulation, property, and part time working.
    I have thoroughly enjoyed 35 years as a full time partner and only wish others could experience the same.

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  • I disagree with the assertion that the GP Partnership Review Group consists of advocates of the Partnership model who are inevitably going to say that the partnership model is the only way going forward. Indeed, as an "Ex-Partner" who now works in (and indeed runs) a group of practices providing an alternative to the Partnership model, I was deliberately invited by Nigel Watson to be a member of the Group, as were a number of other representatives and leaders of other organisations currently providing General Practice services outside of the Partnership model. The group is deliberately balanced to represent a wide range of clinicians and managers providing GP services in diverse formats, including those provided by Partnerships. The remit of the group was to look at the Partnership model and make a series recommendations that, if implemented, would invigorate the GP Partnership model and make it more viable to provide in the future; that is precisely what the Group has done. The report actually goes beyond its original remit in stating that the Partnership model could and should have a future AS AN OPTION to provide Primary Care services in the future. I believe that most GPs will welcome its recommendations and conclusions. The focus of our concerns should be on whether the Government and NHSE have the appetite to implement the recommendations!

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  • Let us hold GMS/PMS in LLPs.

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  • It has already been confirmed LLPs will not be an option as "it provides no further protection". Despite the lawyers and Accountants all being LLPs. The answer is going to be carry with GMS and Fully liable partnerships, but consider extra funded roles (such as pharmacists, paramedics, physicians associates). So no change in terms of liability for the GP and the death of partnerships will continue.

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  • Tom Caldwell

    As soon as increasing the global sum was removed from the scope of this review it was a meaningless exercise.

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  • You are correct sir; the delivery of General Practice through whatever model requires MORE FUNDING and without this proper investment no model will survive.

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  • Any model which supports unlimited work and unlimited clinical risk for limited funding will suffer a slow and natural decline. Every GP partner knows that.

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  • Every GP partner knows the main problems of partnership. Full liability and poor funding. All my junior colleagues are happy to be partners if the global sum is increased enough to reflect our workload and allow the business to have limited liability.If we calculate the funding per patient it hardly covers 1 visit per patient per year!

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  • Profit per patient year in NI is 60 pounds. For all the consultations, visits, blood tests, referrals, LES, DES, data protection, GMC, Defence and Indemnity, PG education, everything, the whole shebang. What does 60 pounds get you these days ? How much lawyer, dentist, plumber time?
    It is a vocation, sure, but is the risk of making a mistake, constant complaint and litigation, the depression, stress and anxiety worth the candle ?
    And yet, against all the odds, more young doctors are in GP training. Just amazing to people like me who see the horrors. Just look at DRs Selu or Bawa Garba.

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