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Changing the rules of the game



General practice has become a house of cards. I am constantly hearing about practices handing back their contracts to NHS England, citing recruitment or financial issues, or a combination of both. What is even more shocking is that these are not in locations you’d be sent to for bad behaviour – they are leafy suburbs with relatively affluent surroundings. 

My own home town of Bristol, the gateway to the South-West, has long been an extremely desirable part of the country in which to live and work. It is one of the most competitive areas for GP training places, but even we couldn’t manage to fill them at the last round of recruitment – and the situation is likely to worsen next year. The town has also seen one of the most recent casualties of the falling cards, when partners at the Northville Family Practice handed back their contracts in October. 

Our partnership contracts belong somewhere in quaint Peter and Jane books

So how can we find the glue to stick these cards together so they don’t tumble down one after another?  In spite of the RCGP propaganda that ‘It’s never been a better time to be a GP’, we all know the sad truth. No one wants to be a GP because the pay and conditions suck. And if you are a partner, they suck even more. 

But something else is also deepening the recruitment crisis and it is the domino effect (sorry, another game reference). Partners in small and medium-sized practices, who see the cards falling around them, are petrified of being the ‘last man standing’ and being left with all the practice liabilities. They RLE (retire, locum or emigrate) and this results in a previously functioning practice suddenly becoming destabilised as it is unable to replace partners. 

Our partnership contracts belong somewhere in quaint Peter and Jane books, while all around us we see the rise of APMS contracts, marketisation of the health service and AQP. We are being asked to compete within a corporate business world, yet we are still shackled by the independent contractor rules of 1948. How many accountants or lawyers are personally responsible for their firm’s liabilities if it goes bust?  The answer is that they are all part of a limited liability partnership, or LLP. This has the same structure as a GP partnership but limits liabilities in the same way as a limited company. The reason GPs can’t change to this structure is simple – it does not allow you to hold a GMS contract or be a vehicle for NHS pensions.

Now, I may be naïve about business and corporate matters, but it is baffling to me that our representatives at the RCGP and GPC have not campaigned for this simple rule change, which might just help us to glue the remaining cards in place and even rebuild. 

Yet in this brave new Tory world, the practices that are handing back their contracts will potentially be taken over by companies on an APMS contract with limited liabilities and nothing to lose. And the house of cards will keep falling.

Dr Shaba Nabi is a GP trainer in Bristol