What next for the GP partnership model?
The profession has changed significantly in the last 5 years, from where giving up a partnership in favour of a salaried position would have been unthinkable, to those resigning from partnerships to take up salaried roles.
Background of the GP partnership model
Decreasing practice funding, increasing patient demand, growing administrative burdens and the introduction of CQC inspections have fundamentally changed the day-to-day workload of GP partners and piled on the pressures of a partnership. GP partners are increasingly dealing with non-medical matters and additional management duties, such as financial management and accounts, recruitment and retention, referral targets and performance management.
These are all critical tasks for any practice, but many GPs joined the profession to be clinicians – to see patients – and are being tasked to take on much larger non-medical workloads.
Not so long ago there were typically 10, 20 or even 30 applications for each GP partner position. Now, with partners taking on an increasing number of additional management duties whilst facing a significant pay squeeze – although there is still a gap in pay between partnership and salaried roles the gap is reducing – it is no surprise partnership vacancies are hard to fill.
Official figures show that in 2009, 69% of all GPs in England were partners while 20.5% were salaried; in 2015, only 55% of all GPs in England were partners while 24% were salaried. In addition, recent research from Pulse, who surveyed more than 500 GP partners in April 2016, found that 51% of partners would consider taking up a salaried role if presented with the right deal and 54% of respondents said they do not expect the GP partnership model to exist in 10 years.
Essentially, partnerships are being seen as a restrictive career choice by many GPs, with salaried positions offering greater flexibility and a better work-life balance; an opportunity to escape the pressures of non-medical partnership responsibilities.
So where does that leave general practice? Is this the end of independent contractor status?
Benefits of the GP partnership model
There are clear benefits of becoming a GP partner; this model of independent contractor status provides GPs with the freedom to advocate for their patients, to run their own business, to steer their own ship and to determine their own future. GP partners also have the stability of employment and the potential to benefit from growth in the profits of the practice.
Having a stake in the business also means GPs are better connected and accountable to the local community, which can not only make the GP partnership model a cost effective and rewarding way for GPs to delivery primary care, but a positive for patients and the local area. Because GP partners own and manage their practices, it is often said that general practice is the only part of the NHS that is truly clinically led.
The future of the GP partnership model
Opinions are divided over the GP partnership model that has helped to shape general practice since the inception of the NHS over 65 years ago. The disadvantages of the system are arguably starting to outweigh the positives; the recent contract imposition and the increasing level of bureaucracy and red tape involved in obtaining practice funding are threatening the benefits of partnership.
There is no perfect solution and it is unclear whether the traditional GP partnership model is sustainable in the long term. Much of this depends on government support and practice funding. The recent publication of the General Practice Forward View package (which we review in detail here) will not solve all of the challenges facing general practice but it does set a new direction and mark a step-change for primary care.
It will be interesting to see how general practice continues to evolve over the coming months and years.
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