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CAMHS won't see you now

Where have all the partnerships gone?

When I look at various sources of advertising for jobs, all I can see are salaried posts. And not many of them. Practices do not seem to want to replace retiring partners with the same.

When I look at various sources of advertising for jobs, all I can see are salaried posts. And not many of them. Practices do not seem to want to replace retiring partners with the same.

This is an important issue, as this trend has been present for a few years now, and does not seem to be improving. I know this because, as the lead course organiser in my patch I am responsible for the careers and welfare of the young doctors who come to train in my patch. As well as teaching and mentoring them, I also generally get asked to provide references.

It is obviously a matter of supply and demand. If we look back at the supply side, it is clear that we are training more young doctors than ever for a career in primary care. I remember that when I started in this role some 20 years ago, we had around a dozen doctors on our training course. It was small and intimate, and had a very collegiate feel to it. It was a good time to be a course organiser, and most of the people I trained were able to get partnerships in the locality. Indeed when I look at virtually every practice in my patch there is somebody in it that I have trained.

For the last 10 years or so we have been asked to train more and more doctors. A dozen or so has crept up, so now we are training 5 times as many (more than 60 at the moment). So every year around 20 finish and look for jobs. This year around half haven't found jobs, several have got salaried jobs and one has got a partnership.

So we are training more, and there is less demand.

Why is there less demand? Doctors are still retiring at the same rate, and we should have more jobs than that. So I looked at what happened when 3 practices local to the Jobbing Doctor had doctors who left (2 retiring and 1 relocating). There was good news and bad news. The good news is that one practice took on their existing GP Registrar as a partner, knowing that the senior partner was retiring. Forward planning. The other 2 practices, that Jobbing Doctor has been supporting with help to become training practices, have decided to replace a doctor with a nurse.

When asked for the reasons for this, their response was salutary. There was too much uncertainty in general practice, they were concerned about their income dropping further (as it has successively every year since 2004), and a nurse could do the job just as well. They were concerned about the development of Darzi-style polyclinics in their locality (although neither have one in their patch as they cover quite ‘leafy' areas)

Jobbing Doctor thinks they are wrong, and these decisions will result in the practice losing direction and momentum. Certainly, their role as training practices will need to be reviewed at some point in the future in view of the changing ethos of the practice and the potential exploitation of doctors in training posts.

But I don't blame them for making commercial decisions. We have to run small businesses, and decisions need to be financially viable. I blame the policy makers whose decisions have resulted in this parlous state of affairs.

I have always had a feeling that no-one in Government really understands general practice. This current state of affairs can be firmly laid at the door of Government.

I have seen it coming for a while.

The Jobbing Doctor

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