Is the partnership model the best one for general practice?
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NW Part of the work we’ve already started doing is to identify its strengths, where it works well. We’re not just saying it’s a partnership model or nothing – we’re looking at its role and what partners add to that.
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AB In Scotland, we have managed to persuade our Government partnership is the best model. They were attracted to a salaried model, but the recent recruitment problems have made them realise salaried is actually going to be more expensive, so partnership is best.
It’s best for the taxpayer because it’s the most cost effective, it’s best for the patient because they have an advocate and we give them continuity of care, and it’s best for GPs because they get the autonomy to organise their business.
Do young GPs view partnership differently to the previous generation?
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PS We used to feel we would settle down and we would provide service to a community for a lifetime of care. But I think the aspirations of younger GPs are genuinely different. They don’t necessarily see themselves serving the same population for 30 years.
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HS I do six sessions as a salaried GP in west London, and also chair the Muslim Doctors Association, so for me and for a lot of my peers, flexibility and having a portfolio really appeals to us.
The last full-time job I did was as a registrar and it was really demanding. The model of 10-minute appointments is really unsatisfying because you feel you’re not giving patients the care they deserve.
What is wrong with the current model of partnership?
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SdG I’m in the situation where I’ve been a partner, I’ve been a salaried doctor and I’m now a locum. I came out of general practice because I found working in A&E significantly easier – which is ironic really.
The thing that strikes me is that it is a completely false sense of autonomy and control. What happens at the moment around the country is that people work in fairly small practices and people even in the same town have no idea what the practice two streets down the road is doing. Everyone’s doing things very differently.
I think if the partnership review can do one very good thing, it would be to try and benchmark ‘normal’ and give people an idea of what works for some people more than it might do for others
What is the benefit of partnership?
SdG When I was a partner, one benefit was that I was an independent advocate for my patients as I was not employed by anybody. If hospital colleagues, who are equally frustrated, talk in the media they get hammered by the hospital.
I’d like to set up my ideal practice, where I could have some autonomy with my workload. I’m sad not to be a partner any more and I think most people who have been partners and given it up feel guilty that we couldn’t hack it.
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CG This is the best description of why we need a partnership model.
What is putting people off partnerships?
PS I think one of the things that worries younger colleagues is the money. I asked my two salaried colleagues a couple of years ago, would you like to buy the building from me? You could buy it from me for £X, I have a financial advisor who will get you the loan you need, from day one you will make £300 to £400 a month each from the rent on the building. They laughed and said, ‘why would we take that risk when we’re not planning to be here for ever?’
NW The problem is younger GPs are coming out with a student loan, they’re settling down, want to buy a house and on top of that you want them to take out a mortgage or say, ‘by the way can you sign a 20-year lease which you’re personally and severally liable for’. They don’t want to do that.
At the time when some of us joined practices and property prices were going up, it wasn’t a risk to sign. It was a positive asset. It’s not that any more.
What immediate things could the Government do to improve partnerships?
SdG It’s little things like putting out good news stories about GPs, trusting GPs with money because GPs generally spend it well on their patients. Stop trying to get us to paint our house with tester pots of money and trust us to spend our money well – and not on an annualised basis. If you want to redesign community services, general practice has to be at the heart of it, but we also need control to do that.
Is there a political will for change?
AB I don’t think there’s anything wrong with the model, but all four UK governments have allowed it to wither. How serious are they about changing this? They have sat on a situation that’s developed over more than 10 years,
It took a while but the health minister in Scotland gets it now and the important thing is to reduce the risk, particularly premises. But the Government in England needs to be serious – this could just all be a charade.
NW I don’t think I’m naive and if I thought it was all a charade I wouldn’t have agreed to take on the role.
I do think they’re serious but I don’t think there’s any particular secret that there are people in government who say that we are a corner shop model, and we should be put in the annals of time – such as in the House of Lords report last year.
But I can assure you that having met face to face with NHS England chief executive Simon Stevens and Jeremy Hunt, when he launched the review as health secretary, they are serious. They believe the partnership model still has value in terms of supporting the NHS.
Part two of Pulse’s roundtable discussion looks at how to reinvigorate the GP partnership model.