The emergence of federated practices and polyclinics in the capital requires new models of GP partnership, said Londonwide LMCs joint chief executive, Dr Michelle Drage. 'The current model of partnership does not seem to be providing (sessionals) with the autonomy they are looking for,' said Dr Drage.

'We are looking at how to create career opportunities, with the benefits of a partnership but without the millstone round their necks of having to own all the infrastructure.'

One option would allow salaried GPs to become stakeholders and run one of a group of practices without investing in property and infrastructure.

Dr Drage cited The Hurley Group, a GP-led organisation running several practices across south London, as a good example. It has six 'local medical directors' employed at its practices who are paid an enhanced salary to take part in practice decision making in the way that a partner might.

These employees can prog-ress to become a profit-sharing member of the group.

Dr Clare Gerada, medical director of The Hurley Group and RCGP vice chairman, said new partnership models were vital to protect the future of general practice.

'We have to make sure there are leadership opportunities for the next generation. The old days are gone - you can't slip straight into a vocational partnership any more.'

Londonwide LMCs is also developing services to help small practices form networks to avoid pressure from PCTs in London. Dr Drage said small practices were still being aggressively targeted by PCTs in London because they did not fit in with the move towards larger, networked clinics.

Dr Drage also expressed concern that NHS London's plans for large 'Tesco-Metro' style health centres could undermine continuity of care. She said Londonwide LMCs did not oppose the 'hub and spoke' model of polyclinic, as long as the 'hub' does not consume investment from existing practices.