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
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READERS' COMMENTS [1]
Please note, only GPs are permitted to add comments to articles
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.