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Stewart Gregory

Partner - Brighton & Hove

21st February 2019

Final recommendations on the GP Partnership Review are published

On January 15 Dr Nigel Watson delivered his Final Report following an independent review into the partnership model of general practice. Whilst the partnership model has always underpinned general practice, and served the NHS very well as a model for the delivery of GP services, it has recently been recognised that partnerships have become less popular with GPs.

The review was tasked with considering the challenges that currently face GP partnerships and making recommendations to transform that model for the benefit of all working in and using the NHS. In presenting his report, Dr Watson’s belief was that his recommendations will “address many of the challenges we face, revitalise the valuable partnership model, and make general practice a great place to work once again.”

In this article we outline the main recommendations made by Dr Watson.

What are the main challenges facing General Practice

Before looking at those recommendations, it is worth recapping on what his review identified as the main challenges facing general practice. These were:

– Workload: changing national demographics are resulting in an unprecedented increase in demand for GP services.
– Workforce: recruitment and retention present a major challenge. GP numbers have been falling over the last few years; an increasing number of GPs intend to leave practice; and the number of GP partners is falling as a proportion of the general practice workforce.
– Risk: an increasing level of personal risk was identified as one of the major factors influencing GPs’ decisions not to join partnerships, or to leave them prematurely. The particular concerns were financial and premises risks: “last man standing”, medical indemnity, and the unlimited liability of partnership.
– The role of general practice in the NHS: as smaller organisations within the NHS, general practices often struggle to “find a voice” to influence policy direction affecting their local communities. The review also heard a lot about the fatigue felt by general practice as a result of the many changes to NHS structure, commissioning, and funding.

Are there positive outcomes emerging for GPs?

Whilst the above are clearly significant challenges, there are already some positive signs:

– trainee GPs who are still interested in partnership at the right time
– record numbers of doctors entering GP training
– rising numbers of general practice staff providing direct patient care
– a guaranteed increase in investment of £4.5bn into primary medical and community health services over the next five years to better cope with the pressures of increased demand, workforce expansion, and new services to meet goals set out in the NHS Long Term Plan
– announcement of a new five-year primary care network contract promising a medical indemnity and funding for investment in staff and IT

Key recommendations of the GP Partnership Review

With all the above in mind, Dr Watson’s review made seven recommendations. Some of these may be considered “low-hanging fruit” that could be fast-tracked to quickly make a difference. Others will require a longer term, strategic approach to implementation. The recommendations of the review are:

1) Reduce the personal risk and unlimited liability currently associated with GP partnerships.
2) Increase the number of, and funding for, GPs and roles that support the delivery of direct patient care.
3) Increase the capacity and range of healthcare professionals available to support patients in the community, through embedding services in general practice.
4) Refocus medical training to increase the time spent in general practice.
5) Establish Primary Care Networks to allow practices to operate in a more sustainable way.
6) Ensure that general practice has a strong, consistent, and fully representative voice at system level.
7) Take measures to ensure that practices can use resources more efficiently through access to IT and innovative digital services.

Dr Watson acknowledges that there is no single recommendation in the review that is the most important. However, it is hoped that any GPs reading the review would feel encouraged by it and recognise solutions that could make a difference in their own practices.

The big question now is whether the government will back these plans. It should be noted that, in putting together the recommendations, Dr Watson’s team have consulted with Treasury officials, so there should be nothing of surprise.

In concluding his report, Dr Watson says: “Doing nothing cannot be an option. The consequences would be clear – the widening of health inequalities, with areas of the country where general practice will struggle to continue, the inevitable rise in pressure and costs in the rest of the health and care system, worsening clinical outcomes, and falling patient trust in the NHS.”

It is our intention to return to Dr Watson’s recommendations in a series of articles looking at some practical points that emerge from them.

For more information on the GP Partnership review or for an informal chat about how we help support GPs contact Stewart Gregory. e

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