GP representatives at this year's LMCs conference have called for the GPC to discuss alternatives to the partnership model, saying it is stifling recruitment and needs to be replaced.
But for every GP saying that a fully salaried service is the way forward, there is another saying that independent contractor status should be actively endorsed and supported.
Fewer GPs have been opting to become partners since the 2004 contract was introduced. The number of salaried GPs has rocketed by 260% in the last 10 years, the latest workforce figures from the Health and Social Care Information Centre show. The number of GP partners has dropped by 9% in the same timeframe.
Partnership can be seen as a restrictive career choice.'
Dr Vicky Weeks, chairwoman, GPC sessional subcommittee
The BMA's largest ever poll of GPs recently found that sessional GPs often choose their role because of the flexibility it brings, with 72% of locums and 58% of salaried GPs saying their post offered a better work-life balance.
Dr Vicky Weeks, chairwoman of the GPC’s sessional GPs subcommittee, says that partnership can be seen as a restrictive career choice.
‘Being a salaried GP instead of a partner gives them the flexibility to develop their career. They can be portfolio careers and follow other interests – gone are the days when you just put your feet under a desk for nine sessions a week,’ she says.
Dr Richard Fieldhouse, CEO of the National Association of Sessional GPs, says that GP partners’ work has ‘radically changed’ in recent years, with the focus now on hiring staff, reaching targets and saving money.
He runs Pallant Medical Chambers, a locum organisation that books work, runs education sessions and provides appraisal and revalidation support for its members.
Locum chambers like this are thriving and branches are now springing up across the country, Dr Fieldhouse says. And almost half of all applications to join are from GP partners.
‘People who have done 20 years of being a GP partner are sick of it,’ he says. ‘They’ve had to develop a siege mentality just to be able to cope.’
Joining a locum chambers can provide flexibility for a GP partner who wants to take a sabbatical and is not ready to leave medicine, Dr Fieldhouse says.
‘A friend of mine who became a locum thought he hated medicine – he was depressed and very stressed,’ he says. ‘But he tried the chambers and realised he loved general practice – he just hated being a partner.’
Dr Fieldhouse says that the partnership model is still relevant, but sees a more flexible approach as practices begin to federate.
‘I think the future of general practice is a symbiotic relationship between GP chambers and GP federations. Where you have well-organised teams of GPs working in practices, and teams of well-organised GPs supporting them,’ he says.
Two-thirds of sessional GPs surveyed said they did not see themselves becoming a GP partner in the future, compared to one third who said they would be looking for a GP partnership.
GPC deputy chairman Dr Richard Vautrey said salaried GPs are put off from becoming partners as they can see the difficulties with managing finances and owning premises.
‘Young doctors are less confident about becoming partners, but the survey does still show that many salaried GPs still aspire to become partners in the future,’ he says.
Dr Weeks believes that while individual GPs may seek better work-life balance, the partnership model itself is vital for ensuring that GPs have a say in how services are run.
‘The independent contractor model does permit innovation with service delivery, and no other model would do that,’ she says. ‘We have developed service care pathways for diabetes and mental health - would that have necessarily occurred with a straight salaried service?
New models of care
‘With the new models of care that are coming up, the independent contractor status is still a significant factor because it allows collaboration and prioritises patient need,’ she added
Dr Vautrey says that reducing workload is key to attracting more GPs into partnerships, as well as boosting funds to ease financial problems.
‘The government has to put its money where its mouth is, and commit to general practice in the long term,’ he says. ‘The investment they’ve provided is welcome but doesn’t go far enough.’
‘There’s still a lot of strength in the partnership model – it ensures all doctors have a voice in the practice, that they are able to take part in the management and decision-making,’ he says. ‘It’s stood us in good stead and it’s something we should be encouraging for the future.’
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