I read with interest your article published in GPonline on 29 November. You raise a number of concerns, about which I thought it would be helpful if I provided more information.
The interim report that you refer to was published at the beginning of October and is therefore two months old and much has happened since then. I have continued to engage with the profession and listened to suggestions and concerns and have developed the emerging recommendations.
The chair of the RCGP, Professor Helen Stokes-Lampard, is a member of the review’s board and two vice chairs of the College, Professor Martin Marshall and Dr Mike Holmes, are members of the review’s working group. The working group has been meeting every couple of weeks and therefore the RCGP, along with the GPC, have made a significant contribution to the development of the emerging recommendations.
Read Dr Blackadder-Weinstein's article
> 'GP partnership review failing to meet the real needs of newly-qualified GPs'
I was aware that the review was going to be discussed at College Council last week but unfortunately due to other pressing agenda items the Review was not discussed so there was not an opportunity debate the issues or receive updated information.
You have expressed the concerns of your committee members as follows:
-
Autonomy is being removed.
-
A new early career opportunity, called Preceptorship, could reduce pay and delay opportunities to experience of providing continuity of care.
-
There is a lack of recommendations to make the partnership model more attractive and reduce the risk and liability associated with partnership.
-
That GPs could be forced to work in networks.
You have also stated that many of your colleagues are ready for partnership when they complete their training.
I understand your concerns and if we are going to ‘revitalise’ the partnership model of general practice we need to make general practice a better place to work and address the concerns.
There are many strengths to the partnership model of general practice which include being part of the community, the freedom to innovate and implement change at pace, it provides incredible value for money for the NHS and importantly the autonomy that it offers. The review is not trying to reduce autonomy and if anything it is trying to enhance this, and I hope this will come through in the final report.
New GPs need training to become partners
We know that the majority of GPs who complete their training are not opting to become partners immediately. Many express an interest to be a partner in the future but at the current time the future looks uncertain, there is no career model, the risks of being a partner outweigh the benefits. During their training they have been prepared for the clinical skills required to be a GP but the curriculum does not have sufficient space for areas such as leadership, business skill, finance, practice contracts, staff issues etc.
The recommendations we are proposing will reduce the risk that partnerships are exposed to, including premises, medical indemnity and also the unlimited liability.
Currently many newly qualified GPs are opting to be locums because they see this as being more flexible, with less risk and allows them more control than the other options. We need to offer an attractive alternative but this needs to be an option and not compulsory, so those who want to enter partnership immediately can do so without restriction.
The proposal for the preceptorship is to offer a newly qualified GP the opportunity to have, for example a two-year contract which has a substantial element of general practice provision with protected time for personal development including having a mentor and time to develop an area of special interest which could be clinical (for example dermatology, diabetes, frailty etc). The funding available needs to be appropriate to the role and sufficient to make the posts attractive. The placement in practices needs to meet the needs of the individuals but could offer the opportunity to work in different practice in a locality.
During this time there could also be the option of additional seminars focused on the business skills associated with partnership, leadership, finance etc.
Expand the GP workforce and networks
To address workload and an inadequate workforce we need to expand the GP workforce and have incentives at the early, middle and end of the career to help recruit and retain these doctors. We also need to have additional funded workforce such as nurse practitioners, pharmacists, mental health workers, paramedics, care navigators and social prescribers. We also need to make better and more efficient use of existing staff such a community nurses who should be co-located with GPs and work as part of a single team.
A network needs to be embedded in practices and cover a defined geographical footprint and attract new resources that help practices meet the needs of that population. It is critical that practices work together, and this will offer more career choice for GPs within the network. I think of the network as a delivery unit that helps practices and will need additional resources.
The final recommendations have not been agreed and will be published shortly. I hope to talk to you and your committee before then because I think we can address many of your concerns.
Dr Nigel Watson is a GP partner in the New Forest area, chief executive of Wessex LMCs and independent chair of the GP Partnership Review, commissioned by the DHSC.
