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No partnership ‘myth buster’ can escape the truth about funding



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My tutorial this week was on GP partnership. It is a topic I had asked for when I started training and we’d just been sent the GP partnership review ‘myth buster’ for trainees, so it tied in nicely. Unfortunately, this was a tutorial that felt like a one-on-one with a bystander, as the other GP trainee barely asked a single question, which is a shame. They did state at the beginning that they had no interest in partnership – although were interested in understanding how things work.

I had a chat with said trainee afterwards; their concern mainly revolved around risk. My view is that you can’t become a partner if you are not comfortable with some risk – no business can be run with zero risk.

Given the profile of some of the people I went to medical school with, I’m not all surprised that there are GPs who don’t want to be partners under any circumstance. That’s fine and everyone is different. If the partnership model is to survive, it’s the people like me – the maybes but not now – who need convincing. There’s a lot of work to be done on that front.

What bothers me about the document on myth busting is that many of the potential benefits described could equally be said of being a salaried GP in a good practice – such as autonomy and continuity of care. Some issues specific to partnership were addressed, like income from drawings, but I thought the whole document would be that specific. Perhaps the authors’ intention was to be broad… or it’s just that positives are in short supply currently.

As a partner, I should be offered pay and conditions to make working eight sessions a week worthwhile

A key personal concern with partnership – assuming the main source of revenue is from a GMS contract – is that the payments are subject to the whims of the government of the day. There’s some protection from a trade union negotiating that contract, but as a junior doctor currently working under a contract I didn’t vote for, that’s little comfort.

Another problem is costs. Right now, indemnity costs appear to do nothing but rise and if a practice wants to recruit and retain staff then it is obliged to meet these. Usually a business can adjust for increased costs by raising prices to the customer, streamlining the goods or services it offers or making changes to payroll costs – for example, reducing hours of work, holding back wage rises or laying off staff surplus to requirements. But in NHS general practice, there are no prices to raise, we can’t cherry-pick the most profitable patients and currently the primary care workforce isn’t growing so the balance of power lies with employees.

Workforce is the key reason I don’t plan on entering a partnership any time soon. Primary care doesn’t have the oligopoly on GPs in the way secondary care does on hospital consultants. As a partner, I should be offered something in pay and conditions to make working eight sessions a week worthwhile. Under the current framework, I can’t see how I could do so and make the liabilities of being a partner worth it.

Secret Trainee is a GP registrar in England