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Why I declined a commercial takeover of my practice

A business enterprise run by a GP recently offered to take over Dr Dinah Roy's single-handed practice. Dr Roy explains whey she refused the offer, despite its very real attractions

A business enterprise run by a GP recently offered to take over Dr Dinah Roy's single-handed practice. Dr Roy explains whey she refused the offer, despite its very real attractions

I am a single-handed GP with some salaried support. I was approached recently by a GP colleague who asked if I wanted to discuss the possibility of help with running my practice.

This GP had recently set up a company that took over PMS practices. He worked with business partners and was enjoying some success taking over these practices, employing the staff (including GPs) and running primary care services. One of the practices he had taken on was local, and the GPs seemed happy with the arrangement.I am always open to new ideas, so we met and discussed things.

The deal was I would become salaried and would receive a payment related to the number of sessions I worked each week. In addition I would receive a profit share, which would be calculated after some profit went back to the company.I went away to weigh up the pros and cons.

Financial considerations

There were a number of financial matters to be considered. The pay offer that I was made was reasonably competitive with the current rate for a salaried GP, and there was the element of profit share. My current position is, of course, that I take all the profit that my practice brings in, and my pension is linked to superannuable practice income. The offer I was being made would leave me with less pay than I currently take home.

As a salaried GP, I would be entitled to an NHS pension, which is dependent on lifetime earnings, although some unresolved issues are currently exercising our negotiators. My income would be guaranteed by contract, so if the practice income dropped (bearing in mind future demands on small practices) I would be protected.

The pay offer I was being made was a minimum guarantee. There was no guarantee that my pay would increase, or that any account would be taken of any specialist work done, although my colleague recognised the fact that other work, for example a managerial role within the company, might attract an enhanced rate.

Would I continue to own the premises and rent them to the practice, or would there be an opportunity to sell them on? Who would pay for course attendance and personal development? These issues would require negotiation.

A question of independence

Why would I want to work for someone else? One reason I chose the single-handed path 12 years ago was that, following a partnership split, I needed to feel more in control of my working life. However ­ salaried or not ­ how independent can we really be? Ethically, legally and contractually, there is much more guidance on, and also scrutiny of, performance than ever before ­ something that I have no objection to.

There is also a risk to a single-hander of professional isolation. Luckily, I have always managed to overcome this and I currently have two other GPs working in the practice, but isolation is always a possibility. Working as a salaried GP within my current practice wouldn't change the position, but there might be more opportunities to work across the range of practices run by the company that had approached me.

At the moment I have the freedom to organise holidays when it suits me, to choose which courses I attend, and to take on extra work occasionally (PCT, GP appraisal, mentoring, out-of-hours sessions and work with various advisory committees). As an employee, I would have conflicts of interest at times, as well as issues about extra earnings. Also, I currently have the freedom to decide which elements of the GP contract I wish the practice to deliver, what I want to do as part of that, and how I want to fill any gaps in core services. I can decide how I want to earn my own living ­ but I also have to make sure that I am attending to that all the time, which does require time and energy. Would that be different under a new arrangement?

Matters of responsibility

It would certainly be an easier life if I didn't have to worry about the day-to-day running of the practice. My practice manager works part time, and a small practice can rarely justify employing the kind of MBA-qualified business manager that larger practices seem to go for these days. So inevitably I am drawn into issues that would be avoided in a different set up, including staffing and admin.

Sometimes this can be a headache, but as a result I work more closely with my staff and I value their support and advice. So on balance I think it is an advantage.We have a great team spirit but, as the boss, I am never an equal team member and the overall responsibility for everything is mine and mine alone. I could walk away from all the stress but I would really miss it. I enjoy having my own business and, even at times of stress, I have not regretted my decision to take on my own practice.

The competitive future

While I might be happy with my lot now I'm only too aware that the future will look very different for primary care. Can any single-handed practice survive? I had to make the decision ­ should I take the money now or carry on, knowing that small is vulnerable?

Also, in future small practices will need to compete with larger providers (many of which may be merged practices) and private providers. So could I compete, for example, on the range of services offered, the skilled workforce required to deliver a breadth of specialisms, extended opening hours, quality of services and achievement of the plethora of targets being thrown at us daily?I'm already wondering where I'll find time for practice-based commissioning, even if it is an enhanced service, and now there are new QOF targets, too. I have just received a capital grant from the PCT to expand my main surgery. It was less than I applied for but we are running out of space: will it be enough in five years' time and can I afford it? Is my practice manager able to take on the challenges that this new agenda presents?These are questions all practices must consider, and my small practice needs to develop a critical mass of skilled workers. The choice must be to go in with others, by take-over or merger, or to develop and expand.

Advice for other practices

The most important considerations are to do with the future. Take a critical look at which services you must provide, and which you think you could set up with a little determination and imagination; what resources you need, including workforce, premises, organisational capacity, time and energy, and what you like doing.

My final decision

Money was not really the issue. I am quite happy with my lot now; equally I felt that I could probably negotiate quite a good deal with the company which had approached me. The main thing was my desire for independence. For better or worse I wanted to remain independent and to get my practice in shape to face future challenges. I am happy in my little practice and I am not ready to give it up just yet.

Time will tell whether I have made the right decision. But for now I shall continue to plough my own furrow.

Pros and cons

Points in favour of being taken over

  • Future probably more secure as part of larger unit
  • Stress of day to day running of practice removed
  • Reasonably competitive pay and pensions package
  • Opportunity to work with other practices

Points in favour of remaining independent

  • Higher earnings
  • More stress ­ but more satisfaction, too
  • Feeling of ownership of practice
  • More in control of working life

Conclusion ­ I remained independent

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