Dr Burnt Out’s five-point plan for a reformed GP partnership model

Dr Burnt Out on the need for a reformed GP partnership model that is fit for the future

At last week’s excellent Pulse LIVE in West London, the minister for general practice Stephen Kinnock restated the Government’s commitment to the GP partnership model as the best way of delivering general practice.

He may well be right. However, like most things in life, models must change and adapt over time to the current conditions for doctors but also wider cultural shifts, changes, and paradigms.  

The simple fact is that nearly all younger GPs (and young people in general) do not want to plan out the next 30 or 40 years of their life. They especially don’t want to bind themselves to a single partnership in a specific locality, with what usually includes a financial and legal commitment, and associated risk especially to a building lease or ownership of crumbling estates and other liabilities. 

I do not see this changing. To me therefore, it seems inevitable that the GP model should reform, modernise and align with the needs and wants of younger GPs. It is only right and fair to do this for the next generation who are currently: emigrating, unemployed, going private, or leaving the profession completely because they see no future in UK general practice.

If this current situation continues, it would be a massive betrayal by the Government but also by the primary care leaders of this younger GP generation. The current primary care model cannot be preserved as if in aspic – unchanging and unbending to current needs and concerns. It must adapt and change to survive.  

Taking place simultaneously to Pulse LIVE last week, on the Euston Road at the Quaker headquarters – was the ‘special conference’ of England’s LMCs. The conference was demanded in December to determine what escalatory steps could be taken in protest against the NI tax hike, but of course also included discussion on the new contract, PCN model, secondary care interface, collective action, and other important matters.

At no point, however, was it ever debated or considered as to whether the actual fundamental model and mechanisms of GP partnerships (including important factors such as unlimited personal liability) needed to change or reform. Surely this needs to be addressed before it is too late? 

The other big news of the week was the launch of legal action on behalf of PAs by the UMAPS union. If successful, this could be financially disastrous for many a GP partner, especially partnerships that have employed many PAs (remember that unlimited personal liability). It seems unlikely that any payouts would be covered by medical defence unions.  

With all this in mind, and there being a current vogue for plans/announcements/white papers etc, below is a five-point plan for a ‘reformed GP partnership model’, fit for the future (oops sorry I think that phrase has been used before for another GP plan!)  

1. To secure the long-term future of general practice, especially for young and newly qualified GPs, the partnership model needs to stay. But it needs to be a ‘reformed partnership model’ to appeal to the vast majority of GPs.

2. ⁠The unlimited personal liabilities for GP partners are highly unsuited to the future of our profession. As part of any reform, these unlimited personal liabilities must go.  

3. ⁠Most young GPs want a form of ‘portfolio’ working with sessions for teaching, CPD, research etc. These sessions should be ‘built’ into a future consultant type contract with similar pay and conditions. Six clinical sessions should be classed as ‘full time’ and there should be paid sessions for non-clinical work like consultants have  

4. ⁠As young GPs are delaying qualifying as they fear they cannot get jobs at GP practices, there should be central funding for GPs on this new consultant type contract with similar pay and conditions as hospital consultants. This may be highly appealing to all types of GP: partner, salaried and locum (this case has also been eloquently made by others, including Pulse editor-in-chief Jaimie Kaffash.) 

5. ⁠The best bits of the partnership model should be retained in this ‘reformed partnership model’. Those best bits include agility, autonomy, clinical independence, working closely together in groups of GP colleagues and continuing LMC and BMA representation and structures.

My warning is this: Do not leave it too late. The personal unlimited liability issue is just the sort of problem that will be left too late – and when there are lots of GP partnerships and partners liable for large amounts of money, fingers will start being pointed at the BMA and RCGP amongst others as to why something was not done about it sooner. 

Dr Burnt Out is a GP locum in London