The Government needs to ‘proactively’ look at alternatives to the ‘withering’ GP partnership model which is threatening the future of general practice, a leading health think-tank has argued.
In a new analysis of the GP partnership model, Nuffield Trust urged the Government to ‘actively develop and test alternatives to partnership’, citing examples such as hospitals running GP surgeries or employee-owned trusts.
However, author and GP Dr Becks Fisher warned against abolishing the partnership model suddenly, arguing that any new models should be tested alongside ‘shoring it up where it is working well’.
The analysis found that the number of GP partners in England has dropped by almost 25% over the last nine years, from 24,491 in September 2015 to 18,425 in December 2024.
This trend meant that partners were the minority among fully-qualified GPs for the first time in June last year, while the number of salaried GPs has increased by 81% since September 2015.
The declining number of partners ‘raises serious questions about the sustainability of the traditional partnership model’, the think-tank said.
Since the shape of the workforce has changed so significantly in the past decade, the ‘decline of the partnership model is a threat to the provision of general practice’, the paper said.
The think-tank said that reform such as this is a ‘daunting task’ as ‘neat evidence-based solutions’ do not currently exist and the Government ‘must retain the support of GPs’.
It recommended: ‘Policy-makers and the profession should work together to agree the purpose of general practice, and describe the outcomes it should achieve.
‘This will help to identify the operational models that best serve these aims, and the type(s) of GP contract that can support them.’
But it advised some urgency, saying the Government ‘needs to protect against the real risk that if GP partners no longer wish to hold contracts – and viable alternatives cannot be found – the provision of general practice in local areas will be threatened’.
The paper recognised that GP partnership works well in some areas, that increasing the proportion of NHS funding spent on general practice – which is necessary – may also ‘bolster partner numbers’.
‘But the government needs to plan for the future and actively develop alternatives,’ Dr Fisher wrote.
These alternatives will depend on how ‘radical’ the Government wants to be, and if they want to evolve current models or design new ones.
‘There are options to create new NHS-run organisations – separate from existing hospital or community trusts – to deliver general practice and offer salaried NHS employment to multidisciplinary GP teams,’ the paper said.
Commenting on her paper, Dr Fisher said alternatives are ‘desperately needed’ but that the answer is not for the Government to ‘simply abolish the partnership model’.
She continued: ‘Rash moves could dangerously destabilise general practice and undermine provision in areas where partnership is working well.
‘Nor is inaction an option: letting the current model continue to wither is likely to result in more practices closing their doors, with disastrous consequences for patients.
‘Instead, we need a strategy that restores the core functions of general practice and supports whatever models sit behind that – sometimes partnership, sometimes other models.’
Prior to Labour coming into power, health secretary Wes Streeting had expressed doubt concerning the future of the GP partnership model, arguing the ‘murky’ GP contract should be ‘ripped up’. However, he has since said he wants to ‘engage’ GPs in the discussion.
The BMA is demanding that the Government agrees to a wholesale renegotiation of the GMS contract before the end of Labour’s parliamentary term.
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Here’s a crazy idea…..why not make Partnerships more attractive so more GPs want them.
Start handing out new GMS contracts to entrepreneurial young GPs to set up shop in under doctored areas.
If “continuity of care” and seeing “my doctor” are really Government aspirations , you need lifers in Partnerships rather than a Trust-run surgery consisting of a fluid salaried GP workforce with little incentive to stick around.
Possibly does not help that the BMA leadership regard private enterprise as bordering on criminal, and that healthcare should be run entirely by the State.
The continuity of care desperately sought by patients and the governemnt will only be possible with support of the partnership model, as any other model with multiple allied health professionals filling in gaps in provision mean continuity is near impossible.
Restart a basic practice allowance which will allow transition of salaried colleagues where they wish to transition to partners without forcing struggling practices to face pay erosion in a deflated pay situation, and try and encourage saalried doctors to step up.
In some practices the partners are earning similar of less than slaried colleagues and locums, so there is no surprise there is often no queue of doctors wanting to take on the responsibility and hours and workload for a pay cut.
Partnership where it is financially supported will provide high quality of care for yeas to come, but need funding to allow us to continue to move care from hospitals and hire those unemployed GPs and improve patient access.
To make the partnership model succeed you need GPs who are going to work close to full time in general practice. Statistically that is something male GPs do a lot more than female. Along with it getting very hard in many places for male patients to be able to see a male GP, we need to graduate a qualify more men and reverse the positive discrimination that started decades ago to ensure women could see women. It’s controversial to say but it doesn’t make it not true.
Any alternative plan relies on multiple tiers of proven failing NHS management who would be required to oversee such change.
NHS England which has overseen unchecked consistent failure & decline across almost every sector of the NHS with no ability to correct their catastrophic decisions.
Remote layer upon layer of ICB managers , many entrenched within their distance remote working silos and often never having stepped into a general practice, focussed on their charts with their input limited to pointing out, nursery level, up down movements in their exquisitely multi coloured bar charts or other graphical representations worthy of a position in the Tate gallery but little else. .
NHS management or ICB board positions across the spectrum, see as a haven for comfortable, unregulated roles, generating up £180,000 plus pension, a grand director or lead title with little with no accountability for visible ineptitude .
Highly paid PCN CDs wasting £1,400,000,000 year on year celebrating their awards, whilst almost every aspect of general practice falls apart around them.
Perhaps it is time, maybe look at reforming NHS managers and leaders as a first step, prior reforming the model of general practice that these same often unaccountable groups have so effectively destroyed .
They talked about this about 6 years ago. What was the outcome?
Why not just allow the contract to be held in limited liability partnerships for a start – would that be so hard?