This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

A faulty production line

Partnership is dead, long live partnerships

Dr Shaba Nabi

dr nabi 100x100px


I am not going to bore you with yet another analysis of the new GP contract, or use phrases such as ‘bear traps’, ‘smoke and mirrors’ and ‘devil in the detail’.

What I am going to do is cathartically discharge my frustration, sadness and fear about the direction of the partnership model.

This multiprofessional vision has been the writing on the wall for some years now. Whereas previously it was born out of the grim imperative of a dwindling GP workforce, the coffin lid has now finally been nailed in place. From April onwards, and for at least five years, any increased funding will be delivered only through the network DES. A global sum pay freeze for at least five years will ensure a speedy burial, and the funeral will be attended by numerous dignitaries from the RCGP and NHS England.

All around me, I see practices scrambling for allies and trying to dodge the baggage, like kids choosing their football team in the school playground. And who can blame them? If all new funding is going to be shared with these guys, I’d want to make damn sure they’re the sort who’ll pull their weight.

So, what exactly is this workforce funding going to get me? An average network of four practices, each with a 10,000-patient population, will receive funding for just 10 hours of social prescribing time and seven hours of pharmacist time per practice per week. This equates to 0.042 minutes of repeat prescribing time per patient. Hardly a formula to get me leading a victory dance, yet this proposal (alongside future reimbursements) has been badged as the cavalry coming to save partnerships from a pauper’s grave.

I see practices scrambling for allies like kids choosing their team in the playground

The fact is, we’ve been sinking for years but no one has had the guts to bury us and start again. Instead, we now have this reincarnation of the partnership model, in the form of networks, promising to save us from excessive workloads, liability and risk.

But none of these issues will be addressed without acknowledging the fundamental flaw within our contract – we are paid through capitation and not by activity. Consultations continue to rise exponentially and patients become more complex with their comorbidities, yet we are still paid a flat rate to service the all-you-can-eat buffet. Until we are paid for the work we actually do, we will continue to be treated like community house officers to secondary and community care, regardless of the structure.

The glimmer of hope is the next generation. At a recent trainee conference in Bristol, the NHS long-term plan and GP contract were presented to delegates by the great and the good, followed by a debate about whether the partnership model had a place in the brave new world. Despite hearing both sides of the argument, trainees voted overwhelmingly to retain the model and embraced continuity of care.

Perhaps they realise that no matter how many leadership courses you go on, scholarship roles you succeed in or fellowship posts you acquire, nothing compares to the unparalleled experience of being a GP partner.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at

Related images

  • dr nabi 100x100px

Rate this article  (4.19 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (15)

  • I quite agree. We all need to defend traditional general practice which has evolved over 70 years and is efficient and works well for both patients and doctors. Getting in an army of noctors will turn us into GP 'specialists' with a very heavy surgery load and lots of responsibility with little to lighten the load.
    I have seen the effect of this locally and the GPs following this route have had to cut their surgery sessions as they are so onerous.
    I think thinning out some of the useless paper work would be far better for morale than adding further noctors.

    Unsuitable or offensive? Report this comment

  • The least worst of two bad options, is not a choice

    Unsuitable or offensive? Report this comment

  • The current model is dying and we should not be intervening. A fee for service model and instantly turns a full waiting room from a headache to an opportunity. If we were all independent contractors billing the NHS for our activity we could all work as much or as little as we chose. The more entrepreneurial among us might want to own buildings and employ support staff in return for a cut of our fees. This model works for lawyers chambers, Australian GPs, and must be the way forward. If we could chose to pay less than 34% into our pension, in return for reduced benefits, that would help. Something needs to change. Alas not for me, I left for new pastures weeks ago.

    Unsuitable or offensive? Report this comment

  • Spot on Grinding Premolars but before they realise this mrs of us will be gone.

    Unsuitable or offensive? Report this comment

  • Forget DenPlan - We need GPplan. Same price as a mobile phone contract £20/month - then we would have the funds to employ the staff who would actually make a difference

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    We are where we are . As I wrote previously, the government (whatever it is or will be) has a serious choice to make . This crisis in the gatekeeper of NHS , namely general practice is now well publicised and nobody (including these traditional anti/GP media ) dares to deny the looming consequences if more GPs walk away with few newcomers. As my slogan goes ,’ the government needs us more than it needs us .’
    The only part which still has ‘doubters’ is Continuity of Care . Working at scale is simply a compromise to survive. That will deem to be ineffective as well if there is further haemorrhaging away GPs. Good to hear that the youngsters believe what we believe ( well , at least many of us). Only time will tell. Ten years down the road , we( hopefully, we are all still alive) might be laughing at our-present-selves in one way or the other . History always makes a mockery on human being.
    And if Continuity of Care is the holy grail , it will always find a way to cease to be extinct . I remain optimistic.
    There is a Chinese saying ,’ The real gold fears no fire in a red hot stove ‘.(真金不怕紅爐火)。

    Unsuitable or offensive? Report this comment

  • David Banner

    Young GPs are smart cookies. Yes, they want partnerships to survive......but they don’t want to be partners themselves.
    And who can blame them? Who wouldn’t prefer a salaried/locum position (with defined workload and salary) over the financially toxic rollercoaster and bottomless workload pit of a partnership?
    Of course, this only works if idiotic older GPs are prepared to cling to the partnership mast and clean up the crappy jobs because the buck stops with them.
    The trick is to be employed by these misguided partners, not some faceless conglomerate who will expect you to dance to their tune, rather than the pathetically grateful drowning small partnership that will be ecstatic for any help you can give them.

    Unsuitable or offensive? Report this comment

  • Shaba this has been brought up at BMA ARM a few times. Initially, my proposal did not make the agenda. When it did, it never got to debate. When it did get to debate it got voted down.

    So really, there is no point blaming the Govt., DOH etc.
    We can change the Contract. The fact that GPs are leaving is a sure sign the current Contract is rubbish.
    We are our own masters to a degree. So, if we accept a capitation fee for increasing workload that is our problem.
    The net result is that profit per patient has fallen 25% and take home pay today per consult is 50% of 2004.
    The DOH looks after public money and they are very happy at how foolish we are.
    Maybe this issue will make the ARM in Belfast this year and we will vote Yes.

    Unsuitable or offensive? Report this comment

  • By the way, this is the ' penance' imposed by Mr Hunt. You must remember he and his cronies in DM think we get paid for playing golf.
    So it is better to be paid per item. That way everyone knows what we get paid for doing everything we do.

    Unsuitable or offensive? Report this comment

  • Interesting theme : Declining numbers of NHS Principal GP's ; Principle Gp's are the backbone on the NHS in crisis but are they getting the support , help and recognition they deserve. I say NO!!
    They are the key to continuity of care for our patients.
    What do our colleagues think?

    Is it right, fair, proper and accountable that numerous locum GP's retain their positions of Chair / Vice Chair on CCG's and LMC's nationwide . Principle Gp's pay a levy to to their LMC , Locum Gp's don't. Senario : Locum GP's charging principle GP high fees for their work in their practices while retaining their executive positions on LMC's drawing fees paid by Principle GP's onlyand in fact doing more paid LMC work as they have more time. The secretary of our LMC thinks this is ok and if fact good because they have more time for LMC meetings despite not contributing any levy. I totally disagree.
    Also our does this equate for CCG's led by Locum GP's?

    Unsuitable or offensive? Report this comment

  • Ivan Benett

    The independent contractor status (and the partnership model) has never been fit for purpose. It was never part of the NHS. It effectively died when Ken Clark introduced a contract that specified what the government should expect from their contract with GPs. So since then the intransigence of the profession to adapt to change, to become more responsive while retaining continuity has mean that the ‘Contract’ has become increasingly explicit and detailed. The less willing the profession has been to become patient responsive rather than doctor orientated, the more the contract has tried to enforce it. The consequence has been that in order to cope with rising demand (for same day as well as long term demand) practices are having to be forced to work collaboratively and to make the most of the seven day working week.
    It is simply not good enough that patients have to wait 3 weeks for an appointment.
    While continuity is the key to the doctor-patient relationship it is also not possible when most GPs do on average that 5-6 surgeries a week.
    It is of course inaccurate to say that consultation rates are rising exponentially, but they are rising. This is mainly due to increasing age of the population and complexity of co-morbidities.
    The way to respond is to argue for more resources and better workforce numbers and skill mix. It also means smaller list sizes, and managing today’s work today. This would allow better access to your own GP and for same day demand to be managed on that day.
    Because partnerships have been managed for the benefit of the partners (with notable exceptions) the government has had to curtail their insular outlook for the benefit of comprehensive and timely service.
    The end of professional partnerships ended with the demise of professionalism as Marshall Marinker pointed out in the 1980s. While we remain Contractors, we will do what the contract tells us to do. And we cannot wind back the clock

    Unsuitable or offensive? Report this comment

  • Ivan. I know not from where you are coming but your criticism of partners as doctor centred, and unresponsive seems unwarranted. As someone working at the cold face of Gp and a partner
    for 25 years, I see changes to give patients what the politicians say they want (rather than what I and other experts believe they need) have gone on apace, and my working life has changed beyond recognition.
    Patients and politicians have champagne taste for beer money.
    Partners will not take the responsibilities and risks without a decent work life balance and income. As an example to the practices you work for of your willingness to be patient centred, rather than doctor centred, perhaps you will work extra sessions for free in the practices in your area where you know patient demand is high. I thought not.
    No one can sustain unlimited demand, and agreeing to every whim of politicians and the unreasonable few patients, would crash the system.

    Unsuitable or offensive? Report this comment

  • I have recently agreed to join a partnership after several years of happy locuming whilst I raised my children, often feeling like I was doing the profession a disservice by locumming for the benefit of my family.
    I now wonder whether I was mad to step foot into a ship just as it starts to sink????

    Unsuitable or offensive? Report this comment

  • @David Banner; unfortunately PCNs are are step in the direction of us being taken over by 'faceless conglomerates'.
    And @Patrick Ryder: I agree but LMCs are on the way out -who in government takesany notice of them? And CCGs won't last either

    Unsuitable or offensive? Report this comment

  • Nothing useful in any of the new contract changes that I can see: the Morris Marina in 1981 gets a facelift but under the surface it is still a Morris Minor from 1948: a bit nerdy but such a close analogy. What happened to British Leyland in the end? Do we miss them?

    Unsuitable or offensive? Report this comment

Have your say