Dr Nigel Watson: We need to make general practice a better place to work

New Forest GP and Wessex LMCs chair Dr Nigel Watson is leading a government-backed review that aims to reinvigorate the partnership model of general practice. He sets out how the review will aim to make general practice a place doctors want to work.

The NHS is approaching its 70th birthday and is viewed as one of our nation’s best loved institutions.

The vast majority of patient contacts - over 400m per year - take place in general practice and over 99% of the population are registered with a practice, yet more often than not any media coverage of the NHS refers only to hospital-based care.

The NHS has responded to the challenge of an ageing population, who have more long-term conditions and complex needs by reducing the share of funding to primary care and growing the number of hospital specialists at three times the rate of GPs.

It is therefore not surprising that general practice is facing a recruitment and retention problem.

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It has been stated on a number of occasions that the ’corner-shop model of general practice has passed its sell-by date and should be confined to history’.

When I became a GP partner 30 years ago there were 170 applicants for the post I was lucky enough to get and all my fellow GP trainees at the time were also looking for partnership on completion of their training. We are told now that GP trainees no longer want partnerships and would sooner become locums or salaried GPs.

With the number of partnership vacancies running at an all-time high (in some places more than 20%) should we move from a predominantly partnership model to an employed one?

Partnerships have a future

My personal view is that the partnership model has not reached the end of the road, it can still have an important role to play in the future of the NHS but we need to make it a better place to work, which will encourage more GPs to remain working in general practice, address the concerns about the unlimited personal liability and with the move to a more population based approach to healthcare ensure that general practice is truly able to play a leadership role in the local NHS.

Most practices have evolved and developed over the last 10 years, despite not having sufficient resources to evolve significantly and could not be described as a ‘corner shop’. We have witnessed a significant number of practices merging to form larger units, federations evolving to be a provider of primary care at scale and networks of practices collaborating together in a way that has not been seen over the last 70 years.

Talking to many young GPs who are completing or have recently completed their training they say that they do not want to go into partnership now but would consider this in 5 years-time.

The health and social care secretary announced in February 2018 that he was going to carry out a formal review of how the partnership model needs to evolve in the modern NHS and agreed this with the RCGP, the GPC, NHS England and the DHSC.

Review challenge

As a GP partner, the chief executive of a large LMC, a fellow of the RCGP (achieved by assessment not nomination) and a long-standing member of the GPC, I have been asked by the health and  social c are secretary to be the independent chair of the review. I have accepted this and see it as an honour but also a great challenge.

I have been asked to review the partnership model and make recommendations by the end of the year as to how this can be revitalised.

The review will consider, and, where appropriate, make recommendations, in the following areas:

  • The challenges currently facing partnerships within the context of general practice and the wider NHS, and how the current model of service delivery meets or exacerbates these.
  • The benefits and shortcomings of the partnership model for patients, partners, salaried GPs, locum GPs, broader practice staff (practice nurses etc) and the wider NHS.
  • Drawing on 1) and 2), consider how best to reinvigorate the partnership model to equip it to help the transformation of general practice, benefiting patients and staff including GPs.

* This blog also appears on the Wessex LMCs website

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