The recent announcement from health and social care secretary Jeremy Hunt about a review of the partnership model of general practice has - not surprisingly - caused concern to the profession. Indeed, the issue of the role of GP partnerships in today’s NHS will form a key theme in this week’s LMC conference.
The chronic underfunding of general practice has destroyed morale, decimated the workforce and led to many GPs leaving the partnership model and, in some cases, leaving the profession altogether.
The profession is regulated and micromanaged to an unprecedented level. The levels of regulation and bureaucracy have made GPs, as independent contractors, the focus of criticism for failings in the wider NHS.
Independence
The independence and freedom to innovate that GPs enjoyed is being eroded by political decisions made over the past decade. GPs’ workload is spiraling out of control and funding is being stifled. Against this backdrop, people may ask - is it still correct to advocate a model of working that is fraught with regulation and pushing GPs out of the profession?
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The total number of GPs (WTE) dropped from its peak of 32,426 in 2009 to 28,874 in 2017. A drop of 10% in less than a decade. The number of full-time equivalent GP partners over the same period dropped from 25,378 to 20,128 - a drop of 20%.
The evidence is very clear - GP partners are leaving the profession at twice the rate of the wider decline in the GP workforce. This certainly does indicate that the partnership model is not considered the same as it was a decade ago. But does that spell the end of the partnership model?
I put to you that it does not.
General practice is the only part of the NHS that is (almost) entirely clinically led, because GPs own and manage their practices. One of the biggest strengths of the model is the freedom to innovate. Most practices are run by GPs working with a small team of clinical and administration staff.
Bureaucracy
Acknowledging that the levels of bureaucracy are increasing in general practice, it is fair to state that GP practices on the whole are not tied down to the same level of bureaucracy and administration of the rest of the NHS. The fact that GP practices respond to change every year with the annual contract is testament to this. GP practices are also able to change and adapt to reflect patient needs in a much more fluid manner compared to the rest of the NHS where change can seem pedestrian.
GP practices are owned and run by ‘local’ GPs in most instances. This promotes stability and continuity of care. The fact that GPs have a stake in the practice, which is in effect a local business, means GPs are connected and accountable to the local community. This unique relationship will mean that GPs are free to act as patients' advocate.
Despite being independent contractors, GP partners can employ and engage salaried and freelance/locum GPs. Again, doctors working for doctors at such a large scale is unique to general practice.
This means that the ‘employer’ can actually relate to what the ‘employee’ has to deal with at a much more minute level compared to the rest of the NHS. This in turn will nurture a much more positive employment relationship compared to the rest of the NHS. Even from a health economics perspective, one would struggle to visualise how any model other than the partnership model can deliver GP services for an average of £146 per registered patient per year.
GP workforce
I could go on and on and on…
Acknowledging that the workforce is changing, and that the demands on general practice services are now different, I would challenge anyone to come up with a model that is more responsive to patients’ needs, more efficient, provides more leadership and innovative opportunities, acts as patients’ advocates and delivers high quality care day in day out. All this while still providing the best care across all the sectors in the NHS (as recently been confirmed by none other than the CQC itself!).
The review of the partnership model offers the profession a unique opportunity to make our feelings very clear to the government that we believe in the partnership model. Let’s get behind it and make the case for a better funded general practice, that is safe, and sustainable and continue to deliver highest standards of care to our patients.
