In a recent conversation with long-time GP partner (and former NHS Clinical Commissioners co-chair) Dr Steve Kell, I found myself explaining the reasons I have avoided the partnership model for most of my career. This was mainly about flexibility and the ability to innovate outside of a practice.
Steve told me that when you find the right group of people, who share your values and you can work with within a trusting supportive environment, then GP partnership can be the most rewarding job a person can do.
Steve Kell is an impressive chap. He is also quite persuasive in his arguments about the strengths and models of general practice, which is hardly surprising given what he has achieved in his career. But I have to say I was sceptical, despite having reservations about some aspects of my portfolio career.
Over the past few years, like many of you, I have sat in meetings where various NHS ‘celebs’ have told us of the value of new models of care. I remember one of the New Models Team saying to a room of Camden GPs: ‘Tower Hamlets is going to blaze a trail for you, so that it is easier for you to adapt in the future.’
If we were paranoid, we might even think health leaders were trying to undermine the partnership model
Someone else later that day said to the room: ‘For nearly 70 years, you GPs have been the bedrock of the NHS, but now it is time to evolve.’
One of the final speakers of the day reiterated this sentiment by saying: ‘The days of a family doctor seeing patients whilst sitting in their house, paid for by the state, are over.’
Nearly all the think tanks, boffins, health commentators and ‘leaders’ when speaking of the future NHS seem to be supporting this view. Of course, they always acknowledge the role that general practice has to play in the NHS. Words such as ‘jewel in the crown’ and ‘bedrock’ are often used.
However, there are undertones of the need to alter the contractual model of our profession. At a drinks reception after a conference, one ‘celeb’ leader told me, we need a way to ‘round up the shopkeepers’ to reduce the variation and waste. If we were paranoid, we might even think they were trying to undermine the partnership model and make us all part of a salaried service.
Working as a locum has given me a perspective of the range of GP practices out there. I have worked in some that I have vowed never to work at again, and at others where I have become part of the furniture.
What is also clear is the impact of underinvestment on workload, workforce and premises. Morale is down, income is down, staffing is thin. Yet incredibly, staff still go the extra mile to see that none of this underinvestment hits patient care in any way.
There is anxiety out there, but it isn’t around STPs, ICSs, ICOs and so on. It’s about whether a nurse will leave for a different job, whether the senior partner will retire or how the practice can’t afford to give a pay raise for the fifth year in a row. But everyone does their best to ensure that none of this impacts on our care for patients.
However, as I continued from one place to another, I realised I was impotent to try to help practices implement the skills and tricks I have learnt (and copied) over the last ten years. I also felt that when teaching, lecturing, mentoring or consulting, without a base, I lacked a little credibility.
Then, a couple of months ago, something magical happened. I did a locum in a practice that I fell in love with at first sight. From day one, there was an aura of friendliness. A feeling of teamwork and, most importantly, a really wonderful stable partnership with a team of GPs I instantly warmed to and respected. All different, but with highly complementary skills and personalities.
There was a desire to do things different. To innovate. To want to be better. It was a big practice, with a really good sense of community. Steve was right. Partnership was calling. And, as luck would have it, there was a Mike Smith shaped space in the team.
So, from 1 June I am to be the latest partner to be appointed to the Maltings Surgery in St Albans. I am very excited about this. With my colleagues, from our own community and space, we are going to preserve the values of the family doctor, innovate to make the job more rewarding and make it one of the best practices to work in England. It’s not a new model of care, it’s simply updating and renovating a tried and tested model of care, that is literally keeping the NHS afloat at the moment.
Viva la partnership!
Dr Mike Smith is a soon-to-be GP partner in Hertfordshire