In defence of the GP partnership model

Ahead of major contract reform, Dr Kamal Sidhu argues the case for the model that has made general practice ‘the jewel in the crown’

Last month’s announcement on the abolition of NHS England is a seismic shift for our health service which will have far-reaching consequences. It came at a critical juncture for general practice, with the Government committing to negotiating a ‘completely new’ national GP contract, and at a time when calls for alternatives to the GP partnership model are getting louder. A recent analysis published by the Nuffield Trust described the GP partnership model as ‘withering’ and a threat to the future of general practice. 

I could not disagree more with this analysis. The partnership model has long been the most cost-effective pillar of what was once the world’s most admired healthcare system. It is this very model that has made general practice so effective – the jewel in the crown. For every pound invested into primary medical care, it delivers an extraordinary £14 return – an unmatched level of efficiency. 

General practice boasts some of the lowest sickness rates as per NHS staff surveys, and the highest productivity within both the NHS and the wider healthcare system. Despite multiple reorganisations over the decades, it has continued to serve successfully while maintaining high public satisfaction. Throughout, general practice has quietly and steadfastly supported many other increasingly strained parts of the system.

Practice partners shoulder significant liabilities and dedicate substantial personal time and effort to ensure smooth operations. Their teams function with remarkable efficiency and minimise waste – especially regarding the most valuable resource: appointments. Unlike trusts that run multi-million-pound deficits and receive bailouts, general practices operate under stringent financial governance, a fact highlighted by Lord Ara Darzi in his investigation into the NHS last year.

Yet, despite this stellar track record, general practice has not only been underappreciated, but actively defunded over time. Its success has often led policymakers to squeeze more from it, rather than reinforce its strengths. There seems to be an element of schadenfreude at play, with the partnership model facing continued disregard, vilification in the media, and misplaced blame for appointment pressures and broader healthcare challenges.

Critics argue that the partnership model is outdated and unable to evolve. But partnerships remain among the most adaptive structures in healthcare. General practice leads the way in technological advancements, from electronic prescribing, sophisticated record-keeping to the early adoption of AI. It has absorbed responsibilities once reserved for hospitals, adopted numerous unfunded guidelines, introduced new access models for patients, and expanded practice teams with evolving roles. The response to COVID-19 was a testament to our agility; practices adapted overnight, safeguarded vulnerable patients, and continued providing essential care. 

Since then, practices have absorbed a growing burden of work from secondary care, often referred to as ‘workload dump’, without additional resources. Even post-pandemic, general practice remains the only part of the system that has expanded capacity to a new high to meet rising patient demand. With waiting times in secondary care now stretching into months or even years, we are doing more with less and unfunded mechanisms such as advice and guidance have kept significant activity out of the hospitals.

The decline in the number of GP partners is not due to an obsolete model, as the Nuffield Trust paper seems to suggest. It is actually the result of persistent underfunding, lack of recognition, and an un-resourced shift of work.

Any salaried model would have to account for the vast amount of additional time and commitment that partners and their teams invest in their practices – time that the system simply cannot afford. Early evidence does not support further rollout of vertical integration with hospital trusts. This approach requires significant funding and workforce expansion while risking decreased productivity and increased financial instability. Bigger is not always better – further vertical integration is likely to result in even larger bailouts for secondary care.

General practice has always been a hub for innovation and early adoption, and the partnership model is well-suited to a rapidly evolving healthcare landscape and has proven track-record. It is well known that the partners are much more likely to stay in the same practice compared to salaried colleagues and hence, supporting the continuity of care, a key cornerstone of the ‘family doctor’ promise of the Government.

We are best placed to deliver the neighbourhood health agenda or further integration as we know the population, its needs and already have relationships with the wider teams. We have already established our ability and willingness to collaborate (in the form of GP federations and/or large networks). Those models offer economy of scale while preserving autonomy and patient-centred approach of the practices and the benefits of being smaller.

Rather than additional reform, it is critical that general practice teams are adequately resourced. Policymakers must trust the evidence-based model that has consistently delivered results. We need a stronger emphasis on self-management, greater societal responsibility, and honesty from political leaders about what the healthcare system can sustainably provide. Funding must follow the activity.

With appropriate investment of resources, trust and parity of esteem, general practice can offer the best of both worlds—a sustainable, efficient, and highly responsive system that continues to serve patients and communities effectively. Its inherent flexibility and resilience must not be ignored.

Dr Kamal Sidhu is a GP partner in Durham