When I asked other First5 members of the College what they thought of the GP partnership review interim report, the recurring theme was 'autonomy'. Many had become GPs attracted by the autonomy to manage their patients, autonomy in the practice where they work and autonomy in their career.
Ironically, their concerns about this paper on partnership - a way of working that is touted as delivering all of these desirable features - was that autonomy was actually being removed rather than preserved.
Firstly there is the concept of ‘preceptorship’ for newly qualified GPs, which the report describes as a developmental role based in a number of practices, offering a ‘mixture of general practice, a chance to develop an interest in clinically relevant specialties and leadership and exposure to partnerships’.
‘Preceptorship’ role threatens GP pay
I initially saw this as a positive recommendation but talking to First5 colleagues I found their views to be markedly different. Concerns were raised that this could be forced on individuals at a lower sessional rate than that attracted by salaried, partner or locum work. There were also worries that this model would further delay the opportunity for newly qualified GPs to experience continuity of care for patients, already felt to be missing in training, by moving them around regularly.
Some of my colleagues have taken up partnership on completion of training and are revelling in the role. However, when they went for interviews the rhetoric preceded them that newly qualified GPs were not ready for partnership. They felt that their assessment was not being based on their skills and experience, but on being part of a group of newly qualified doctors who ‘don’t want to work the hours, don’t value continuity…’ etc. This language only serves to further divide our workforce and usually comes from GPs ‘projecting’ what millenials want, rather than from the mouths of millenials themselves.
Modern GP contracts for a modern world
Many new GPs do want partnership and feel ready for partnership - but they want a partnership that makes sense in the current world, not tied to contracts negotiated decades ago that they can see are contributing to the burn out of their potential partners, contracts that dictate they work eight sessions a week to be a partner, when they know they provide a better and safer service to their patients with a reduced clinical session working pattern and the opportunity to take on alternative roles that still ultimately contribute to the general practice landscape.
They are not scared of partnership. They just refuse to enter a legally binding contract naively.
We felt that a lot of this report has already been covered elsewhere, rather than presenting innovative improvements to partnerships to make them appropriate for the 21st century and the current and future demands on general practice.
Limited liability for GP partners
Why is there no mention of a contract that includes limited liability partnership? Why is there not more focus on providing all partners with training to supervise the many multidisciplinary team members we are becoming responsible for?
Why is there no outline of how partnerships will be supported in adopting the primary/secondary care interface IT we so desperately need?
Is this review driving us into primary care networks and potentially reducing autonomy?
These are some of the changes and solutions that might make partnership a better offer, not only to newly qualified doctors but to existing partners alike.
- Dr Blackadder-Weinstein is chair of the RCGP’s First5 Committee
