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Dilemma: DES losses row

The local area team has refused to pay your practice income due from work on a DES. When you discuss what went wrong, it transpires one partner made critical mistakes. Another partner argues they should personally meet the costs lost.

Dr Catti Moss: Most partnership deeds would make all partners pay

Dr Catti Moss

This is a dangerous situation for the partnership, and probably means that there have been unresolved partnership issues building up over time.

The situation is quite likely to build up into a conflict which will either result in one or other of the conflicting partners leaving, or a complete split within the partnership.

The first thing to do is to give everybody time to think about the issues. Arrange for a partners meeting with this issue as the only agenda item, at a moment when you won’t be disturbed, interrupted or cut short. All partners should re-read the partnership agreement before the meeting and asked to consider what would improve the situation. See if the partnership can agree on someone (not either of the warring partners) who will lead on this issue. 

Before the meeting, the lead GP should talk to the two partners separately to find out how they see the situation. The GP should also consider what management failures led up to this particular loss of income, and what the ideal resolution might be. 

It is possible that the partner who failed to implement the DES properly had simply been away from the relevant meeting and no one had informed him or her of the correct way to implement the DES. It is possible that this might be a symptom of stress, burn-out or underlying problems. It is also possible that s/he has been consistently failing to support the partnership for years.

Similarly, the angry partner may have personal or stress-related issues underlying this event, such as serious financial problems, anger towards other partners, and a history of creating conflict within the partnership.

Legally, the practice as a whole will be financially responsible and the agreement will make this plain. There will almost certainly be a clause in the agreement allowing a partnership to expel someone who does not perform in a way that financially supports the partnership, but this is a dangerous path to take and would need skilled legal advice.

The best outcome is to find out the stresses that underlie the reactions of the two partners and to introduce systems to support both of them. The practice can then either deal with the deficit by cutting costs, or acting to improve income in the future.

Action following this dilemma depends on whether there are other partners, how much of a senior role the practice manager has and whether there is a ‘senior’ or managing partner.

Dr Catti Moss is a GP in Guilsborough, Northamptonshire.

Dr Jagan John: Work out why you’re out of pocket

Dr Jagan John - online

The initial practice discussion should be with the local area team if there can be any compromises made or other ways found to save the situation. GPs should also scrutinize the DES contract to understand where the confusion came from.

The partnership will also need to work out how much it expected to earn from the DES, and how much money it actually made, before resolving the situation. While partners will still feel angry, the practice will need to discuss how they agreed to implement the DES, especially to work out what the monitoring arrangements were.

Next, schedule a partners meeting including the partner at fault. Before you meet, ask is he or she has got a history of this kind of thing, and were similar incidents resolved conclusively? There may be a performance issue that has not been addressed yet.

Try to reach a consensus viewpoint on the immediate effects of this incident, and the practice´s stance on roles and responsibilities going forward.

Finally, if this course of action fails you may need mediation though staff or external advice from legal teams. Let´s hope it does not come to this.

Dr Jagan John is a GP in Barking, chair of Barking and Havering LMC and clinical director of NHS Barking and Dagenham CCG.

Bob Senior: Take it on the chin

bob senior - online

This is a difficult situation and one can understand the anger of this particular partner.

All the partners need to examine the partnership agreement carefully to find out if it allows for the partner at fault to bear all the financial consequences – most partnership agreements will not cater for this. 

If the partners think the individual has been completely negligent then this might be covered in the agreement, but it is perhaps more likely that the partner will leave rather than pay up.

In any case, it would probably be unfair to lay all the blame at one partner’s door. The other partners should have made sure that they knew what was going on with the DES as the year went on, rather than only becoming aware of it now.  If they didn’t take an interest in how things were progressing, they shouldn’t complain now if things have turned out badly.

The partners probably need to take it on the chin as a practice cost, and treat it as a wake-up call. Partners should take a closer interest in the performance of the enhanced services contracts as the year progresses.

Bob Senior is chair of the Association of Independent Specialist Medical Accountants and head of medical services at Baker Tilly