A part-time partner sometimes seems over-stretched by outside commitments and occasionally neglects practice work, which causes friction. How can we resolve this?
Medicolegal view: Schedule a meeting
All doctors have a duty to raise concerns if they feel that patient care or safety is being compromised.1 One of the senior partners should arrange a meeting with the doctor in question so that he or she is made aware of the colleagues’ concerns.
The part-time partner may not be aware that the work outside the practice is creating problems for colleagues or that this could be putting patient safety at risk. Where practice work is being neglected, and colleagues do not pick this up, clinical care is likely to be compromised.
Doctors must provide a good standard of practice and care, not only during patient consultations but also when dealing with administration, such as referral letters and reviewing and acting on investigation results.2
During the meeting, provide specific examples where patient care may have been put at risk if colleagues had not stepped in to help. Any incidents or complaints should be investigated so that the GP has an opportunity to reflect on his or her practice and consider what action needs to be taken to address any deficiencies. This may have to include scaling back on some activities.
It may be appropriate for a formal arrangement to be agreed for a colleague to take responsibility for these tasks when the part-time doctor is not available.
If the part-time partner does not show insight or take remedial action, it may ultimately be necessary to raise concerns about them with NHS England, or with the GMC. If concerns are not raised or dealt with and a patient is harmed, the practice is likely to be criticised for not taking action to address the problem.
Dr Kathryn Leask is a medicolegal adviser for the Medical Defence Union
Dr Nigel Watson: Agree appropriate boundaries
Many GPs with outside roles achieve a more balanced life, are happier as a result, and can bring back knowledge and skills that are beneficial to their practice. A portfolio career can also allow individuals to develop interests that will keep them fresh and enthusiastic and remain as a GP for longer. This can be achieved, but it requires both sides to be open and honest, and to see things objectively from the other’s perspective.
Firstly clarify whether the outside work is undertaken in the GP’s own time or in practice time. If in their own time, you should have clear boundaries between the GP’s own work and the practice’s. The more boundaries are blurred without clear understanding and agreement, the more likely you are to experience conflict.
If it is during practice time, you should be clear about the time commitment and that the practice work is covered adequately, either financially or by another colleague.
The best way to then take things forward is for one of the partners to have an informal discussion with the individual and express the concerns. Hopefully, you will then be able to jointly address the issues from both the practice’s and the individual’s perspective, and agree to review the situation in three to six months’ time.
It may be worth discussing with an impartial colleague, such as a representative of your LMC. Always try to find a solution that both parties are happy with.
My partners have always been supportive of my outside LMC work. I always agreed work done during practice time with them, and any funding received went into the practice. When I went from full time to part time, we agreed the sessions I would work and only change these by mutual agreement.
Dr Nigel Watson is a GP in Hampshire and chief executive of Wessex LMC
Dr Grant Ingrams: Refer to your practice’s partnership agreement
Hindsight is wonderful. Potential disputes like this can often be avoided by having an up-to-date, formalised, signed partnership agreement and ensuring partners adhere to it.
Consider whether the external work is beneficial to the practice. For example, it may be related to potential additional funding streams such as occupational health, CCG, medical school or deanery work. It may give the practice enhanced knowledge about developments, or how to maximise income through the LMC, GPC or CCG. Or it could enhance the profile of the practice, say through media work. Outside work can also improve job satisfaction and reduce the risk of burnout and should not be discouraged per se.
Collect evidence of what harm is being caused, for example: what work the partner is not fulfilling; any negative effect on the practice’s capacity to provide a service; and complaints from patients or staff. Check if the partner adhered to the partnership agreement, for example by seeking agreement before taking on the external work.
The senior or executive partner should then discuss the situation with the GP, to see if they are aware of the problems they are causing the practice. This may be all that is needed.
If this does not work, convene a full partnership meeting. Resolution may involve the partner decreasing their outside commitments either voluntarily or by requirement of the partnership, decreasing their sessions and partnership share, or incorporating their external work into the partnership. Each of these solutions has its pros and cons.
If the partnership cannot reach agreement, then you should ask the LMC to mediate. The last sanction would be for the partner to leave the partnership – either voluntarily, or by expulsion. However, even if there is a partnership agreement in place, this may incur extortionate legal bills and, particularly for PMS practices, risk losing the contract.
Dr Grant Ingrams is a GP in Leicester
1. GMC. Raising and acting on concerns about patient safety; paragraph 7.
2. GMC. Good Medical Practice; paragraph 15.