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A faulty production line

Are young GPs’ career choices killing off partnerships?

Dr Maham Stanyon and Dr Nishma Manek debate this thorny question

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We millennials and our funny ideas are wrecking general practice; that’s how the argument usually goes. We can’t hack being full time, haven’t the stamina to be partners and our obsession with ‘portfolio’ careers will bring the whole house of cards down.

But what should we do when everything points to a sessional career? Take our training. It fails to prepare us to take on all the roles in general practice that need filling. GP registrars do a gruelling seven clinical sessions, albeit relatively protected in terms of debriefing and support, and are in practice nine out of 10 sessions a week; we are the most regular fixture in the practice after the coffee machine.

While this does wonders in terms of developing resilience to the rigours of the clinic, it provides little exposure to the challenges of people management, finances and the politics of partnership. We are shielded from all of that – perhaps justifiably – but how are we meant to gain any idea of what the business side involves?

This discrepancy is there from day one of specialty training, leaving post-ST3s with their new CCTs fearful of joining practices as a partner. And after qualification, practices are reluctant to hire newly qualified GPs as partners, while the rapidly diminishing GP workforce means more locum doctors and salaried positions are needed to cope with demand. You can’t blame us for going where the jobs are and what we are trained to do.

What should we do when everything points to a sessional career?

Trainee burnout at ST3 is under-recognised, and there is no routine monitoring of how many trainees leave after specialty training. But I know that, for those that survive this process, the perception is already there that a full-time career in general practice may not be desirable, or even possible.

The idea of partnership as the pinnacle of a career is becoming outdated. Furthermore, the individual financial burden of living in large cities, especially London, means many trainees are unable to commit financially to a partnership.

GP trainees completing training may have ambitions to be a partner one day, but if the profession wants us to play a leadership role we need to be offered the opportunity to develop this during training and immediately after. Until then, many will take the sessional route.

Dr Maham Stanyon is a GPST3 in London


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Partnership isn’t for everyone, nor is it the best way to deliver care in every community. But before we blame millennials for the possibility of its demise, it’s worth remembering the observation, often quoted by US healthcare expert Don Berwick, that ‘every system is perfectly designed to get the results it gets’.

I recently did a straw poll of 30 newly qualified GPs across the country. Most said they planned to stay in locum or salaried posts for now, but a third of them wish to become partners within the next five years. So the perception that all registrars will seize a one-way golden ticket to hop onto the sessional carousel is just that – a perception, based on generational pigeon-holing.

I’ve crossed paths with a few young GP partners, and hearing about how you can shape the direction of your practice is appealing. The autonomy, the ability to innovate and be truly invested in improving care beyond the patients in front of you, is a unique strength of general practice. And I suspect it played a big part for most of us in choosing this career.

But we’re seeing a subtle difference in what trainees value in their future careers. As with other sectors, flexibility, control and a better work-life balance are becoming more important. There are legitimate worries that need to be addressed, such as fear of being the ‘last (wo)man standing’, but none of these is a reason to write it off. I think the partnership model can and will adapt, even as large-scale general practice becomes more widespread.

We’re seeing a subtle difference in what trainees value in their future careers

At the same time, it’s a daunting prospect. Not because we’d prefer to clock out at 5pm in time for Love Island, but because it’s an unknown. I’ve heard very little about what partnership can offer during my training, nor have I learned the skills that I think are needed.

The pendulum has swung so far the other way that I see newly qualified partners, or those intending to be, almost embarrassed to put their hands up in support of it. It’s no longer seen as a goal to aspire to, the pinnacle of your career – but a liability. That needs to change. If we wish to sustain the partnership model, part of the responsibility lies with our seniors to show us its value, and help us feel confident and proud in making that leap ourselves.

Dr Nishma Manek is a GPST3 in London


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Readers' comments (13)

  • Azeem Majeed

    Thank you for your article, Maham and Nishma.

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  • Tom Caldwell

    As I have written elsewhere newly qualified GPs are increasingly viewing full clinical sessions of GP as unsustainable, and they are right.

    Unfortunately the colossal work load is not going to go away. As such those already lumbered with the increased hours of partnership increasingly have to pick up the inevitable slack that those working patterns bring about.

    If this was recompensed by a large uplift in global sum then partnership would (possibly) be worth the considerable stresses it comes with and more would wish to pursue it, sadly this is not going to happen.

    Instead more will be forced into employing allied professionals where they see a need for a GP. This will play beautifully into the hands of larger providers keen to maximise profits by employing cheaper staff.

    Whilst no-one can blame you for wanting flexibility and a sustainable work life balance and to maximise your income, there is an inevitable cost attached to accommodating the ways in which you wish to work. Someone does have to pay for and do the work that is not being done. This is why partnership is unattractive because at the end of the day... its the partners carrying the can for a smaller and smaller financial reward.

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  • Why oh why is there so much focus on this?

    the job is too intense for 'full time' and most that do 6-8 sessions do 35-60hrs/week anyway.

    the thing that is killing off partnerships is indemnity, rising costs, and the constant stream of crap we get thrown our way.

    THIS IS NOT THE FAULT OF MILLENIALS - just as brexit isnt - the DoH have underfunded, and the media undervalues GPs - thats whats killing the profession.

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  • And CQC will sue you if you do not name your manager, never mind the pay cuts and the workloads.
    You are wise not to be a Partner. The DOH does not want you to be one, anyway.

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  • Tom Caldwell

    All for one... you must remember though there is no conspiracy

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  • Local full day locum rates in my patch are £600 to £650 for 16 + 16 and 2 paperwork, telephone calls, tasks, pathology, constant interruptions, liaising with the stressed practice manager, CCG meetings etc
    Times that by a 4 day week over a 40 week year and you are looking at an income of 96 to 104k per annum...
    No wonder newly qualified often choose locuming....I probably would if I were in their shoes again

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  • Being a locum is a no brainier, as the differential between partnership and no partner is zero, or negative. Remember that the NHS only provides a list of patients for partnerships. That's all. They don't provide a surgery ( think land architects builders mortgage) or staff or furniture or equipment. And they don't provide intelligence and management and problem solving. It takes 5-10 years to get a practice up and running, and until that happens your practice will underperform financially.
    Locum s fail to realise this , they often think that the office they are sitting in comes at zero cost. It doesn't.
    Until differentials are recognised it would be madness for any new GP to consider paying for a practice so that others could benefit. Where is the point in that? Liability yes. In which other business does the franchise owner allow employees to work less than they do and yet earn more money?

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  • Can't blame them . It's more about money and rotten deals from partners not many want to be tied to. One can't marry anyone has to be an attractive match. So a messy , long hours, poorly paid etc

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  • On the contrary, I think that Partnership will start self-selecting only the most ambitious and capable, rather than just being seen as the natural end point for all and sundry,

    The flip side is that this is all well and good, but then no can complain if the future of GP is indentured, salaried servitude; rota'd and controlled and paid for the 8 hour days you seem to desire. The Locum market is already saturated, there's no way I'll pay a newly qualified GP as much as what we earn a session, so how long before attitudes change?

    It's also a bit of a shame to hear excuses like "oh well training hasn't prepared me". Training is pathetic and barely prepares you to be a doctor, some initiative and self-directed learning is required, surely his is one of the joys of being a GP? I do despair.

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