Recently, kindly patients have been asking ‘Have you joined the practice permanently doctor? Only I’ve not met you before.’ When I tell them that no, I’m just here as a locum, their response is often along the lines of ‘Oh, don’t you want to be a partner then?’ (although occasionally it’s ‘Oh, so you’re not a proper GP?’ to which I usually reply, ‘That’s right – I don’t suppose you know which end of the stethoscope I insert first?’).
This is not an environment in which partnership is the least bit attractive
The truth is no, I don’t want to be a partner.
The traditional and historical benefits of partnership were very attractive – close patient relationships, significant autonomy over work and the freedom that comes with running one’s own practice as a business. However, these benefits were largely accrued when patient and secondary care demands were much lower, when doctors were not so constrained by guidelines and when the money coming in to the business from notional rent and fairly generous contracts far exceeded the money coming out. Don’t get me wrong, GP partners worked extremely hard and deserved their reward, and had on call responsibilities that the younger generation of GPs are fortunate to avoid.
Now, we are working within a primary care system that cannot keep up with demand. We must continually prove to our organ grinders that we practice guideline-driven and evidence based medicine. Relative funding is being squeezed whilst the cost of practice rises at a practice and personal level. I don’t necessarily begrudge this – I have always enjoyed being a doctor and have found general practice the most rewarding aspect yet – but this is not an environment in which partnership is the least bit attractive.
Even with my extremely limited knowledge of macroeconomics, business is fundamentally dependent on the laws of demand and supply. In almost all business environments when demand increases supply either increases accordingly to meet it, or prices rise to relieve pressure and optimise profit. In the business of general practice with its well documented recruitment and retention crises, supply cannot be increased and there is no system to ameliorate demand.
Furthermore, business survival in such challenging times requires ruthless business acumen. I certainly don’t possess this, and I’m not sure how many GPs do – we are GPs first and foremost.
Imagine yourself pitching general practice on the Dragon’s Den. You sweatily enthuse about your business idea which – get this – is based on unprecedented and limitless demand, with ever decreasing financial and logistical resources. You perspire in the direction of Deborah Meaden, and try not to clam up as you explain how the future of your business is entirely unpredictable and dictated by external forces. As your pièce de résistance, you wink at Peter Jones as you tell him your business has unlimited liability.
Now imagine what Duncan Bannatyne will say as he pierces through to your hippocampus with his stare.
For that reason, I’m out.
Dr Danny Chapman is a locum GP in east and south Devon
