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Stewart Gregory

Partner - Brighton & Hove

10th December 2018

The GP Partnership Model – fragile but not dead

In February 2018, the then secretary of state for health, Jeremy Hunt, committed to an independent review of the GP Partnership model, to consider how it needs to evolve to meet the needs of a modern NHS. That independent review is currently ongoing and is being led by Dr Nigel Watson. In October, Dr Watson published his interim report that sets out a number of key areas of concern following consultation with GPs across the Country. We have reviewed the report and summarised some of its findings below.

Is the current GP Model in decline?

Earlier this year a GPOnline poll found that “only one in five GPs say a partnership role is currently the most attractive career option in general practice”. In addition, in autumn 2017, official data from NHS Digital revealed a loss of some 2,000 partners (8% of the total) in the two years to September 2017. Then, just last month, the chair of the RCGP acknowledged that the model is no longer working in certain parts of the country, and that alternative ways of delivering healthcare would have to be found. There are definite concerns about the future of the partnership model for GP practices.

GP Partnership Review – Interim report summary

Dr Nigel Watson’s interim report has set out a number of key areas of concern that appear to be contributing to the decline in GPs’ partnership aspirations. The most significant of these being underfunding, rising workload pressures, premises liabilities and indemnity risks. Whilst the interim report provides no direct solutions to the issues raised, it does make some recommendations which will form the final report due to be published early in 2019, and is seen as an opportunity to “reinvigorate” the partnership model that has served general practice so well for so many years.

The GP partnership model is fragile but not dead – In the words of Dr Nigel Watson himself, whilst the model is “fragile” it is “not dead” but “doing nothing is not an option”. The report does emphasise a range of important benefits of the current model and in particular the ability to change, adapt, and innovate expeditiously, as independent contractors, separate from quite the same levels of bureaucracy as often afflicts other parts of the NHS. Other benefits referenced include being part of a community; the desire to succeed as business owners; and value for money.

Workload – Workload is a major factor and the current problems with recruitment and retention clearly impacts on this. A range of areas are being examined including the impact of regulatory change; access to support services; identifying administrative tasks that do not need to be completed by a GP; focus on disease prevention; more self-care and self-management; and the use of technology to support patients.

Workforce – The need to increase GP numbers is critical. The report focuses on a wide range of training needs to address this. The core aims include making general practice a better place to work; making partnership more attractive than being a locum; expanding the multi-professional team working with and supporting GPs; creating primary care networks that will support practices; and use more of the existing resources to deliver frontline care.

Risk – It is vital that the risks associated with the GP Partnership model are reduced. Key issues under review are lease holding and property ownership; introducing a comprehensive state backed indemnity scheme and addressing the issue of unlimited liability.

In addition, the report starts to explore other issues such as the status enjoyed by GPs and how GPs can become part of the health system’s senior leadership. These are all complex issues that clearly go beyond any regulatory, process driven or legal remedy. However, the summary to the report is that “general practice needs to be valued: it is vital to the future of the NHS and rests on the partnership model.”

A significant risk to the partnership model identified in the report is that around property issues. We will return to these shortly in a follow up article.

Contact our specialist Healthcare and GP Team

Rix & Kay’s specialist Healthcare and GP Team is led by Stewart Gregory. Stewart has some 20 years’ experience of working with a wide range of health sector clients, helping them to plan, develop and manage primary care estates.

If you would like an informal discussion with Stewart to discuss any issues around your estate then please do not hesitate to contact him:

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