With the news that an ‘alternative contract’ will be offered to GP practices from April 2017 comes the clearest indication yet that NHS England and the Department of Health want GP practices to work more closely together, more specifically with groups of patients in excess of 30,000. Although the details of the alternative contract are not yet known, there is an assumption that it will be more rewarding both financially and from the point of view of what I call the ‘bureaucracy-clinical work balance’.
The ways that GPs can put themselves in a position to apply (or bid?) for the alternative contract include forming federations and super-partnerships. One would assume that these structures will need to be in place and functioning well before taking on the alternative contract in 18 months.
A colleague described being a GP partner like being on a small fishing boat in a very stormy ocean
Our practice has recently paid into and signed up to what looks to become the largest super-partnership in the UK – Our Health Partnership. As with other local practices the decision to join or not hasn’t been easy. An organisation that doesn’t actually formally exist, that is being created through the sweat and labour of a few committed GPs and colleagues, cannot offer any certainty about the future. There are risks and opportunities in abundance.
About 12 months ago a colleague described being a GP partner like being on a small fishing boat in a very stormy ocean. All hands are on deck and the direction of general practice is very much determined by elements beyond our control. We can only hope to ride the waves and use our experience to ensure that we don’t get sunk or shipwrecked.
Our Health Partnership doesn’t change the fact that the storm around general practice, and the wider NHS, hasn’t abated in the last year. If anything the waves are higher, the winds stronger, the currents deeper and the rocks more jagged. What it provides is a larger ship. It offers shelter for those weather-beaten, drenched workers who need some time below decks. It provides the opportunity for those elected to steer the ship from the bridge, taking into account the needs and desire of all on board.
There are ambitious hopes that size will provide the opportunity for savings due to the ability to negotiate for, among many other things, better indemnity deals, property maintenance contracts as well as enhanced services across the city. Being part of a larger organisation inevitably means the loss of the ability to steer one’s own course. Though I would argue that being tossed about on the wild seas of general practice in a small boat that the amount of autonomy and independence one had was an illusion. For now it feels as though we can steer our way to calmer waters.
Dr Samir Dawlatly is a GP in Birmingham
