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Alternatives to partnership

The face of general practice is changing: where partnership in a practice was once the goal of the vast majority of young GPs entering the profession, since the late 1990s the number of salaried and sessional GPs in the workforce has increased dramatically, to the point that they now make up between 25 and 50% of the local GP workforce.

It is likely that the reasons for this are two-fold. While partnership positions remain hotly contested, with many applications for any position that becomes available, at the same time another notable shift has happened; women now make up more than 50% of medical school applications.

So what does this shift towards a salaried workforce mean for the future of general practice?

While the long held perceptions of salaried GPs as ‘staff grade doctors in dead end careers' is, thankfully, a thing of the past, the long-held appeal of a partnership is impossible to ignore. The investment, professional and financial, that partnerships require are often the spark that leads to a great deal of innovation in general practice.

However, the changing nature of the general practice workforce highlights a need for flexibility in working patterns that goes some way to explaining the massive increase in sessional and salaried GP numbers.

Partnerships, by their very nature, carry with them an expectation of commitment that salaried positions might not.

Salaried GPs, more easily than partners, can enjoy flexible, fixed working hours, leaving them free to explore their other interests – medical journalism, teaching, or honing a special clinical interest, while avoiding the extensive managerial responsibilities that go hand in hand with being a GP principal. Their exposure to a number of practices and populations can provide a completely different perspective on patient care to that of GP partners, attached to a single practice.

Conversely, the benefits of GP partnership go some way to explaining why, despite the increasing numbers of salaried GPs, it remains something that many still aim for. Beyond the remuneration, which is likely (though not definitely when on-costs are added in) to exceed that of a salaried professional, partnerships offer GPs unequalled job security while allowing them to stay in one area, providing continuity of care to a community they know and that knows them. Partnerships instil management experience that is the gateway to career developments ranging from undergraduate teaching to clinical leadership.

The answer is not clear cut, and the benefits of partnership versus salaried working, as with their respective pitfalls, are plain to see. Within this new landscape of clinically-led commissioning, perhaps it is rather the case that the partnership model is something we should move away from, and that we should instead be looking towards newer models of collaborative working.

The RCGP federated model, with practices joining and collaborating the share expertise and resources, is one such model where, irrespective of status as either a GP principal or a salaried GP, joined up working can be successfully applied to providing high quality care to a community. In this ‘post-Bill' world, we will need to find ways of working together across skill sets, practices and communities, so an end to the partnership/salaried debate – and divide – might just be the way forward for the future of patient care.

This article has been published as part of the Pulse special report on employment, which will be published in the issue out on Wednesday 18 April.

Dr Clare Gerada is chair of the RCGP and a GP in Kennington, south London.