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At the heart of general practice since 1960

The Dragons' Den of GP partnership

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Recently, kindly patients have been asking 'Have you joined the practice permanently doctor? Only I’ve not met you before.' When I tell them that no, I’m just here as a locum, their response is often along the lines of 'Oh, don’t you want to be a partner then?' (although occasionally it’s 'Oh, so you’re not a proper GP?' to which I usually reply, 'That’s right – I don’t suppose you know which end of the stethoscope I insert first?').

This is not an environment in which partnership is the least bit attractive

The truth is no, I don’t want to be a partner.

The traditional and historical benefits of partnership were very attractive – close patient relationships, significant autonomy over work and the freedom that comes with running one’s own practice as a business. However, these benefits were largely accrued when patient and secondary care demands were much lower, when doctors were not so constrained by guidelines and when the money coming in to the business from notional rent and fairly generous contracts far exceeded the money coming out. Don’t get me wrong, GP partners worked extremely hard and deserved their reward, and had on call responsibilities that the younger generation of GPs are fortunate to avoid.

Now, we are working within a primary care system that cannot keep up with demand. We must continually prove to our organ grinders that we practice guideline-driven and evidence based medicine. Relative funding is being squeezed whilst the cost of practice rises at a practice and personal level. I don’t necessarily begrudge this – I have always enjoyed being a doctor and have found general practice the most rewarding aspect yet – but this is not an environment in which partnership is the least bit attractive.

Even with my extremely limited knowledge of macroeconomics, business is fundamentally dependent on the laws of demand and supply. In almost all business environments when demand increases supply either increases accordingly to meet it, or prices rise to relieve pressure and optimise profit. In the business of general practice with its well documented recruitment and retention crises, supply cannot be increased and there is no system to ameliorate demand.

Furthermore, business survival in such challenging times requires ruthless business acumen. I certainly don’t possess this, and I’m not sure how many GPs do – we are GPs first and foremost.

Imagine yourself pitching general practice on the Dragon’s Den. You sweatily enthuse about your business idea which – get this – is based on unprecedented and limitless demand, with ever decreasing financial and logistical resources. You perspire in the direction of Deborah Meaden, and try not to clam up as you explain how the future of your business is entirely unpredictable and dictated by external forces. As your pièce de résistance, you wink at Peter Jones as you tell him your business has unlimited liability.

Now imagine what Duncan Bannatyne will say as he pierces through to your hippocampus with his stare.

For that reason, I’m out.

Dr Danny Chapman is a locum GP in east and south Devon 

 

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Readers' comments (15)

  • "Even with my extremely limited knowledge of macroeconomics"

    ...Surely that should be microeconomics if you're talking about demand and supply

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  • Azeem Majeed

    Current workload and funding trends in the NHS are making it less attractive to be a GP partner.

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  • The partnership model was traditionally good for doctors and the NHS as the only reasonably efficient part left. Sad that this has been eroded. I always aspired to becoming a partner but reducing autonomy and income continues to put me off.

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  • Interesting article. I don't think you can compare GP partnerships with other businesses in the sense that there is a set amount of money given to you for the year (and additional performance related income QOF, DES, LES etc) from which to run primary care services at your practice. How efficiently you run this and achieve performance targets determines your income and the profit is then divided amongst the partners. In a traditional business there is no ceiling to income and growth of the company and conversely there is no guarantee of any income at all! Therefore GP Partnership model would not appear on Dragons Den.

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  • GP practices can advertise locally to expand their practices and now that practice boundaries have gone GP practices could expand further. The problem is that because of the expense and lack of GPs and nurses to do the work the extra gross income is less than the expense. So profit actually goes down. It is only viable to expand if one has a high £ per patient per year. That is decreasing regardless of GMS, PMS and possibly APMS as well. So there is no financial incentive to grow the business. In fact practically all GP practices could be deemed to be breaching their contracts if patients can not get a same day appointment, regardless of whether it is deemed an emergency or not. As an example NHSE could look at the number of patients in a practice that attend walk-in centres, contact these patients and assess if they could not get a same day appointment.

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  • too true; GP partnership within a NHS funded system will never win over the Dragons.

    But pitch it to them as a private enterprise without the restrictions of fixed or reducing income; with a high demand due to a failing competitor ie NHS. Then they may take note!

    dentists did it...why cant we?

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  • The dragons would laugh so hard at such a pitch their heads would explode.

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  • Matthew Murray @2.04

    The big difference between dental practice and GPs is that dentists have charged for some part of NHS care and are paid according to activity. This has never been the case in NHS General Practice. Why did GPs agree to such a contract in 1948? It does not exist anywhere else, without at least some caveat.

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  • pretty sure Richard Branson hasn't laughed his head off at primary care; nor degraded himself to Dragons Den; just got his foot in the door and waiting for the NHS to fail ; )

    guess a private enterprise will depend on your location and patient demographics....or your ethical stand point

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  • The fact is that partnership model was never good and never will be.
    The public demand is a result of our of doing, the philosophy of patient advocate and many other reasons.
    GPs are partly to be blamed for the current state of GP partnerships.

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