The 10-year plan signals the end of the GP partnership model as we know it
Editor Sofia Lind on what the Government’s wide-ranging NHS remodel plans will mean for the future of GP partnerships
The Government’s new 10-Year Plan is billed as a bold reset for the NHS – and general practice is at the centre of the upheaval. But behind the language of opportunity lies a quiet certainty: this signals the end of the partnership model as we know it, and the final death knell for small GP practices.
Two new contracts are being introduced – one for ‘neighbourhood providers’ and one for ‘multi-neighbourhood providers’. They’re described as optional; a complement to existing models. But the scale of these new structures, and the fact that trusts will be eligible to hold them, leaves little doubt about the direction of travel. Crucially, ICBs will be commissioning these contracts. There may be no stated intention to replace the partnership model – but the effect will be similar.
We’ve seen a decade of slow attrition: small practices closing, partnerships becoming harder to fill, funding increasingly routed through PCNs or centrally defined pots like ARRS. This plan doesn’t reverse that trend – it institutionalises it. If neighbourhood contracts are awarded to large provider groups or trusts, there is no viable future for small independent practices.
And for partners who opt to cling to the old model? Will those practices which aren’t part of these neighbourhood models be expected to refer into the larger neighbourhood hubs for the new community outpatient appointments? What would be the clinical – or contractual – logic for that? Patients won’t register with practices that no longer hold responsibility for their care. The partnership model, already fragile, would be functionally redundant.
This raises another question: who will represent GPs in this new landscape? If contracts are held by provider organisations – some of which may have no GP partners at all – then what role will the BMA’s GP committee play? GPC may find itself negotiating a contract on behalf of people who no longer exist in the model. If providers employ GPs rather than represent them, GPC’s democratic mandate disappears.
That should be a real concern – not just for the BMA, but for the profession more broadly. Because what’s being lost here isn’t just a business model. It’s the independent clinical voice of GPs in shaping the health system. That voice is already being eroded, and without structural protection, it won’t return.
NHSE primary care director Dr Amanda Doyle, herself a GP, says there’s ‘no aim’ to replace partnerships, and that trusts will only step in where general practice doesn’t. But that reassurance doesn’t match the reality in many areas, where partnerships are already stretched to breaking point and younger GPs are reluctant to take them on. Simply offering a larger contract structure and then waiting for practices to fail is not neutrality – it’s strategy by omission.
We’re also told that the plan offers hope for the growing number of unemployed GPs. But there’s no clarity on how new roles will be created, or whether these will be secure, well-supported clinical jobs. What we risk instead is a fragmented service, with GPs increasingly disempowered, working within systems designed and led by non-clinicians.
Most crucially, we still don’t know how any of this will be funded. Dr Doyle acknowledges that shifting activity out of hospitals will require money to follow – but says this is still being worked out. That’s not good enough. These decisions are being made now, with real consequences for the shape of general practice.
This plan may not abolish the partnership model overnight. But it creates a system in which small practices are no longer viable, GP contractors are no longer central, and representative bodies may no longer have anyone to speak for. It’s a structural end – just with soft edges.
And if we are witnessing the end of the GP partnership as we know it, the Government should be honest. Because quietly replacing independent general practice with salaried, trust-led provision is not reform. It’s an unspoken exit strategy – and one that risks silencing the profession in the process.
Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn
READERS' COMMENTS [14]
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Super article, Sofia. Says everything I think is true about what’s really happening.
If not even now, when will the BMA get its act together and withdraw from fake negotiations and ballot all GPs on a summer of industrial action and protest, taking our argument to the airwaves and the public.
Don’t let the scheming politicians destroy traditional general practice, the foundation of the NHS, and pass it into distant memory while further enriching the opportunities for private entities in Pharma, IT and Business for profiteering and rent seeking and extraction.
This Govt appears to be very open to seeking new ways to funnel taxpayers money, on the pretence of going to the NHS, to the private sector.
I think you are correct. It is now clear that NHCs will be allowed to patients. So among the doctor mix there will need to be GPs. Last time Polyclinics were tried it was at tail end of a tired government and more importantly, most GPs were Partners so were tied to their practices. This time too few are Partners and many more are Saldocs who can be mobile and can go to work in the NHCs if the T&C there suit them better. Whether this is better for patients remains to be seen but i agree that the small practice partnership model is unlikely to survive this “working at scale” competition
*register patients – crucial missing word..
Absolutely spot-on, Sofia Lind. General Practice, the “bedrock of the NHS” – and much of its cost-effective nature – is being done away with. With specious claims of “GP-centricity”, whilst actually delivering existential threats, this is grand scale betrayal of what patients are being promised. It’s a Darzi re-hash of 20yrs ago; polyclinics, with no consideration of why the idea was rightly panned. One polyclinic per borough isn’t any patient’s understanding of ‘care closer to home’ – it’s a dissembling of app/remote/virtual – anything but seeing an actual doctor when a patient has decided they need to. As polyclinics drift downstream from secondary care, the lack of double-running will be a debacle. As they drift upstream from self-referrals and app diagnosis, the increased demand will overwhelm worse than now.
Politicians, so fond of lauding France and Germany – which UK General Practice surpasses by miles – seem hell-bent on destroying a key element of what is good and actually works for patients and for the Health system. There has to be a reason and it isn’t evidence.
Both Thatcher and Blair believed it necessary to smash the profession in order to control it. With a big 30yr helping of McKinsey advisors, the only winners are the consultancies and their clients. Costs will not fall, but patients will – as more Centenes, VirginHCRGs, and other private sector providers scoop the NHC, Virtual, and AI contracts. A mealy-mouthed national betrayal.
Came to the same conclusion as well after reading this plan.
Everything a GP surgery currently does is to be done elsewhere
NHS App the “front door to health care/ doctor in your pocket” is the new location for your health record.
vaccinations and chronic disease management to be done by community pharmacy soon.
Alternative location for treatment – in new health centres, alternative contracts , alternative career paths for GPs and on and on….
Add APMS contracts whether held by profiteering GP partners who also hold their own GMS contract or private companies to the erosion of Primary Care via the further insidious introduction of PCNs ( salaried GPs holding APMS with no other GMS contract should be offered conversion to GMS if they so wish).
The decline since the introduction of APMS , PCNs ,ARRs all with common denominating factor of giving control to poorly qualified , inept , continually failing ICB,CCG , NHSE managers or inexperienced government officials whether by vast lists of KPIs they do not understand themselves but gives these NHS managers unwarranted power ( a major oversight in our profession not being able to resist this trend) and power they neither deserve or can manage as we witness from decade to decade of failure.
The majority of NHS managers are not managers but simply senior admin staff with the unjustified title of managers.
The RCGP has presided over an abject failure to represent General practice over decades in my view and has served only to gain its leaders grand titles bestowed by Royalty and by they should certainly not be considered Royalty within General practice.
That’s not to say Primary Care does not need reform and one major aspect in my opinion is performance management of those who shirk both responsibility and work over entire careers and more recently the newer class of staff who have no idea of what they are seeing and simply request blood tests, ask patients to rebook for the same problem or write ‘unable to contact patient’ after allowing the phone to ring once yet are paid for doing absolutely nothing . This generates additional work and costs. Unfortunately, we must accept some further form of performance management is required for each and every NHS worker including partners and all doctors as although those in these groups are few , the costs and detriment they cause far exceeds this.
NHSE , ICBS , CCGs, PCNs and the government have gradually and wilfully dismantled primary care via gradual and insidious shifts of power to questionably qualified inexperienced managers and government officials.
It is not too late for those with sufficient strength such as the BMA who demonstrated an unlikely success with the junior doctors pay review and continue to fight against other oppressors such as the GMC . The BMA is not perfect, and neither are any one of us, but they do a difficult job.
As repeated elsewhere , we already have the neighbourhood solutions via local General Practice . The government needs to invest in GP practices, and we need to be open to more individualised performance management on a productive development all basis , as well as promoting recognition of significant unseen work e.g. safeguarding meetings , results , referrals , letters etc etc.
For once , rather than self-promoting ineffective speeches , why does the RCGP not take a more robust definitive stand alongside the BMA to resist a ludicrous 10 year plan doomed to failure and wasted resources or will many of us continue with our ongoing decades of waste of RCGP subscriptions.
It’s been pretty clear for decades that the constant restructuring of the NHS, especially Primary Care, is taking us to the goal favoured by all political parties. A corporate controlled health care system focused on profiteering at the detriment both of patients and clinicians.
The partnership model should have been abolished years ago. The workload is overwhelming, the risks are too high, greed is encouraged, conflicts created. “In March Stephen Kinnock confirmed the government’s commitment to the partnership model.” That was warning that they were out to get rid of it.
I wouldn’t worry too much. The process will take years. Starmer has done more U-turns than a cabbie. Wes is looking for the top job himself. Farage will take control in a few years. The partnership model will be the least of our concerns.
The partnership model has been on the hit list by government for years. It’s the lack of control they hate..
There’s never been the will ( legislation) nor funding to change this.
Difficult to imagine how a 10 year plan will work when the current lot have only 4 years left.
I basically agree with this article, but i cant say i disagree with the overall strategy published. Its one of the more deliverable plans i have seen any government publish. Partnerships are failing everywhere in reality, and if bigger organisations with supportive services, like HR, recruitment, quality assurance et al then so be it.
Problem Jim is that hospitals are failing even more than partnerships given the deficits they run up. Can they really be trusted to manage primary care and not tank that into the red as well.
GP Partnerships are the only part of the NHS that are not in the red
I would love to see how much this will all cost. The partnership model still exists, despite the baleful glare of Jeremy “how to undo the NHS” Hunt and others, because it is cost-effective. I’m still here completing tasks at 8pm because I’m a partner but most salaries doctors will rightly have a firmer boundary on their work time. Does NHSE really think it can make up the shortfall with AI apps?
Partnership is definitely the most cost-effective. But this 10 year NHS PLOT is not about costs really but about power and capital. This 10 year gaslighting Plot lays out how Govt will be catering to the interests of their (neoliberal school) paymasters – corporates, lobby groups and the rich. The NHS will likely become high cost but debt and the taxpayer will fund it, as always. Check bailouts, water and railways etc
I think general practice and the partnership model is dead in the water and the writing is unfortunately on the wall we are just witnessing a slow car crash . The agenda for a while had been to clip the wings of the independent contractor model as its perceived as a profit making exercise for partners whereas in terms of value for money and cost effectiveness it’s still even in its awful current state the best value for money in the NHS. This has in no small part been perpetuated by the profession allowing this to happen through greed on just being blind sided . A great many partners moan about lack of interest in younger doctors not wanting to ‘do the work ‘ or being interested in partnerships but the reality in many cases is that those same partners didn’t want to drop their very good incomes to support this opting instead for cheaper salaried drs and now for ARRS staff but the Pandora’s box is now well and truly open so as the old adage of be careful what you wish for rings true . I fear it’s too late to turn this one around goodbye to partnerships