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General practice has changed, and the way partnership profit shares are calculated must reflect this change to avoid a sense of injustice, says Dr John Couch

An open and fair method for calculating profit shares is an essential requirement for a partnership. For most GPs the better aspects of nGMS have been in force for several months. With the demise of OOH work and increase in part-time working, it is important to ensure that profit shares are still accurate as unfair discrepancies may have crept in unnoticed.

For example, consider a GP who previously worked 30 hours during the working week but did no out-of-hours cover, while her six partners worked full time (40 hours) also covering the OOH commitment, with 10pm-7am and weekend deputising cover excluding Saturday morning surgery. She received 65 per cent of a full profit share.

Now that the practice has opted out of OOH work the same 30 hours should be worth 75 per cent based on the 40-hour week worked by the others. With full profit shares for this practice worth £100,000 her profit share would rise by £10,000. This should be corrected.

The new GMS contract has raised other issues. While ordinary consultations still form a large proportion of an average week's work, there is far more additional work to do. Existing jobs, such as IT, have expanded. And there are now many other tasks that require GP input including:

·GPwSI

·enhanced services

·QoF.

In addition, GMS practices can now employ salaried GPs. In many cases some of this time is used to free up partner sessions to allow greater focus on making nGMS a success.

It is therefore no longer possible to use consulting time as a measure of profit shares. The whole expanded range of non-consultation items must be considered.

For instance, a partner who has dropped two consulting sessions in order to ensure QoF points are as high as possible would be rightly miffed if her profit share fell as a result, especially since top marks earn around £25,000 per partner!

How should profit shares

be calculated?

There are broadly two methods which can

be used:

·traditional

·flexible.

The former is still the most commonly used method and assumes that all partners

on a similar profit share should do the same amount of work.

This was generally measured in terms of consultation time, with allowances for work such as GP trainer work.

Generally little or no allowance was made for non-clinical activities, with the expectation that this was part and parcel of being a partner and that this workload was also evenly spread.

The big advantage of this system is that it usually encourages similar levels of commitment. This can, however, lead to tensions if one partner is clearly not pulling his or her weight. It is also less flexible when extra work arrives and has to be either divided out or fitted in to one partner's workload with subsequent juggling of others.

The flexible approach allows more latitude both in terms of current activity and future changes. It employs two important elements. The first is this: partnership work is measured in terms of time fractions with no distinction between consultations, other clinical and non-clinical activity. As long as the work has been approved by the group, it counts. The second element is a points system. This allocates points for the agreed time fractions for each partner. To calculate an individual's profit share, that person's points (the numerator) are divided by the grand total of everyone's points (the denominator). The example on the left illustrates this.

There are several benefits to this system. It clearly recognises and accurately rewards all types of work done on behalf of the partnership. This should provide positive reinforcement for both hard work and partnership profits. Also, it allows (within reason) each partner to work at a level that suits them and their families best. It plays to each partner's strengths. Finally it is relatively easy to incorporate changes. Most practices do this once a year.

If there is a drawback it is that there can be a more competitive element with a points scheme and unless decided and agreed on openly, jealousies may creep in. Partners must be prepared to allow harder working colleagues to earn more!

Example of points system

Anytown practice awards two points for each hour worked. The type and amount of work done by each partner is agreed annually. This is based on business need and each partner's strengths and preferences.

The total amount of weekly hours each partner wishes to work is also considered in the same way. Drs A, B, C and D work

4 days, 4 days, 3 days and 4.5 days respectively. The results can be seen above left.

John Couch is a GP in Ashford, Middlesex

What changes need to be made?

·Practices currently using and wishing to stick with the traditional method of profit share calculation must now look carefully at their definitions of work. To keep equality, all work must now be included in the calculations. In the same way, work that has now disappeared ­ such as OOH ­ must be removed.

·Each partner's workload must be listed to ensure that work is still spread evenly. Part-time partners' profit shares must be re-examined to ensure they are accurate.

·Partnerships with points schemes are in a better position, particularly if they review the scheme annually. It is still worth ensuring that new and extinct work has been allowed for.

·Some practices may decide that, in this brave new world of nGMS and salaried GPs, a flexible points scheme is now the fairest and most accurate way to ensure profit shares reflect work done. Such a scheme is not difficult to set up.

·All practices must reflect any changes to sharing ratios in their practice agreement, the only safe way to maintain harmony.

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