The 'historic' partnership model should be phased out, with GPs in England becoming salaried NHS employees, according to a report from the Institute for Public Policy Research (IPPR).
A salaried model would fit with current employment trends, the think tank argues - with GPs increasingly rejecting partnership roles in favour of salaried or locum work - and improve NHS capacity to deliver primary care at scale.
Shifting to a salaried service would also improve the quality of care by allowing 'doctors to be doctors' rather than managing businesses and buildings - allowing appointments to be extended to 15 minutes and helping GPs to reduce their working hours, the report says.
The BMA and RCGP however, warned against abandoning the partnership model of general practice - warning that a salaried system was ‘not the solution’ to the current pressures facing the profession.
The recommendation comes just a week after NHS England announced plans to breathe new life into the GP partner model by offering first-time partners a ‘golden hello’ worth £20,000 - and just over a year after the publication of an independent review set up to find ways to revive partnerships.
The IPPR report also suggested that practices should work together in integrated trusts, known as 'neighbourhood care providers' (NCPs) to 'join up primary, community and mental health care' and offer local access to diagnostics - and criticised primary care networks (PCNs) for their failure to develop close links.
It recommends that senior GPs should be recruited into management roles within NCPs, while newly qualified GPs would be offered salaried roles. Like PCNs, NCPs would join up primary, community and mental health care across communities of between 50,000 and 100,000 people.
The government should also borrow money to enable £500m to be invested each year over the coming decade on improving primary care premises - to build '1,300 new primary care hubs and investment in new technology', the report says.
Last August, RCGP chair Professor Martin Marshall predicted that GP partner numbers in England would continue to fall in the immediate future but insisted that the long-term future of the model was secure.
Responding to the report, Professor Marshall said the college was ‘hugely supportive’ of the partnership model which allowed GPs to ‘innovate in the best interests of local populations’.
‘Scrapping the partnership model is certainly not the solution to the pressures facing general practice, improving patient access, or meeting the government’s target to build the workforce by 6,000 full-time-equivalent GPs,' the RCGP chair said.
‘Last year’s independent review into the partnership model clearly stated that it is an important model, and viable career option for GPs at all stages of their careers – but that there are key issues that need addressing, most salient being the need to reduce unnecessary workload in general practice and expand the workforce.’
Pressure on GPs
BMA GP committee chair Dr Richard Vautrey said the partnership model was the ‘backbone of general practice’, allowing the practices the autonomy and independence to innovate.
‘There are, of course, areas for improvement, but the underlying issue for any family doctor - regardless of whether they are salaried or not - is the pressures facing general practice as a whole; increased patient demand, underfunding and chronic shortages of staff.
‘The changes brought in through primary care networks should, in time, improve the provision of care to patients – as this report highlights – without the need to change the entire model of general practice.'
The number of GP partners continues to fall rapidly in England, with official figures showing there were nearly 700 fewer doctors in partnership roles in September 2019 compared with a year earlier. In FTE terms, the drop in partners is 959 - a 5% decrease over the past year.