Government must incentivise partnerships over locum work, interim report warns

NHS leaders must develop incentives to make partnerships more attractive than locum work and rebalance the GP workforce, according to interim findings from a major government-backed review.

GP partnership review chair Dr Nigel Watson
GP partnership review chair Dr Nigel Watson

Factors undermining the GP partnership model are largely inseparable from the drivers behind the wider GP crisis, the report from the independent GP partnership review warns.

Tackling the declining GP workforce, rising workload, risk around premises and indemnity, the status of general practice and its role in leading local healthcare systems are key to finding solutions that can revive the partnership model, according to review chair Dr Nigel Watson.

Addressing these issues is 'the key to the future', the interim report says. It warns that making general practice a better place to work must be the first priority - and is only way to 'unleash' its potential.

Heavy workload

Currently, the GP workforce is inadequate to meet demand, heavy workload is driving the recruitment and retention crisis and the risks of partnership outweigh the rewards, the report warns. Community health services around general practice have been eroded and left care fragmented, while access to new funding is often bureaucratic and fails to support frontline care.

However, the report sets out emerging views on how to tackle workload through better systems to manage demand, use of technology and wider practice teams. It highlights the need for more GPs in substantive roles, but in more flexible working patterns, backed by other non-medical staff.

Working at scale in GP practice networks, federations or other groups can help practices take on greater leadership roles in their local healthcare systems, the review says, and take on more work moving out of hospital.

The review also sets out plans to create new roles to support GPs in the early and late stages of their careers, when they face greater risks of GMC investigations, and to help develop them to take on substantive roles, or help retain their experience in the workforce for as long as possible.

Status of GPs

It highlights plans to establish general practice as a specialism with equal status to that of a hospital consultant, calling for legislation to add general practice to the GMC's specialist register.

The review also highlights plans to explore ways to ease risk for GP partners, potentially through allowing them to hold contracts through limited liability partnerships, employee-owned or social enterprise models.

Partnership review chair Dr Watson, a New Forest GP and chief executive of Wessex LMCs, told GPonline: 'I remain optimistic about the future, I can see huge potential if general practice receives the appropriate level of support.

'I would like government and the profession to read the report and reflect on the contents and then help us develop the solutions. So far the feedback has been very positive - many have said it identifies the correct areas and they like the solutions emerging and it has given them hope.'

Solutions

He added that both health and social care secretary Matt Hancock and NHS England chief executive Simon Stevens had read the review, adding: 'I think we all agree on the problems and now need to agree on action.'

Dr Watson said in the report that visits to sites around England as part of the partnership review process had identified practices doing 'some amazing things', adding that many 'could do so much more with even greater support'.

Ultimately, the report says, general practice 'needs to be valued'. The report adds: 'It is vital to the future of the NHS and rests on the partnership model.'

GPC chair Dr Richard Vautrey said: 'This interim report identifies many of the problems consistently raised by the BMA that must be solved if the partnership model is to be reinvigorated, not least dealing with unsafe workload pressures and managing risks that so often outweigh the benefits of becoming a partner.

'Workforce recruitment and retention issues, spiralling indemnity costs, premises risks, and other financial liabilities all ultimately fall on the partner, and they must be tackled if we are to make the model more appealing to both today’s GPs and those of tomorrow.'

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