LMCs demand 'limited liability' GP partnership model

Limited liability should be introduced to the GP partnership model to stop GPs being exposed to potentially millions of pounds worth of costs if they hand back their contract, LMCs have said.

LMC delegates at the 2018 England LMC conference called for the GPC to negotiate with the government to introduce limited liability to GP partnerships, along with full reimbursement of the cost of providing NHS premises. Delegates also backed calls to introduce a statutory cap on the liability GPs are exposed to if they end up being the ‘last partner standing’.

GPs backed the motions after hearing from speakers including Devon LMC's Dr Rachel Tyler - who said her Plymouth practice had been forced to hand back its contract in 2017 after three years of struggling to recruit.

She told the conference: 'We were an innovative practice. We recruited nurse practitioners, paramedics, physios, pharmacists. We merged with a neighbouring practice almost tripling our patient population. We were attempting to work at scale. But the reality was in our part of Plymouth – deprived, under resourced, spiralling locum costs – the partnership model is dead.

‘Once you lose a critical mass of GPs it becomes virtually impossible to recruit.’

Sleepless nights

She said the practice was left with no choice but to hand back its contract, at a time when it had 22,000 patients, a large number of employees, a mortgage on one property and two non-negotiatiable leases on other buildings. ‘Our liabilities ran into millions,’ she told the LMCs conference.

‘There were many sleepless nights when I pondered bankruptcy and losing our family home,’ Dr Tyler told the conference. ‘My non-medical husband was entirely perplexed as to how someone who had dedicated their life to the NHS could be forced to take the financial liability for a failing government body in the way no other public servant would ever have to.’

Dr Diana Hunter from Cambridgeshire LMC said that the liabilities faced by partners were driving GPs out of partnerships and preventing younger GPs from even considering partnership as an option.

‘Take unlimited liabilities and financial responsibility for staff and sprinkle with a very generous mix of underfunding and unpredictable income and you have a toxic mix – a recipe for disaster,’ she said. ‘These liabilities are instrumental in the continunal demise of the partnership model which many of us believe is the bedrock of general practice.’

Latest workforce figures show that depsite a small increase in the overall GP workforce, the number of partners fell dramatically between June and September 2018. Numbers fell by more than 4% – from 19,576 to 19,342 over the period.

Dr Tyler also said that the GPC needed to quickly explore alternatives to the partnership models in areas like Plymouth where it has been ‘dramatically’ weakened.

‘Unless we reduce this intolerable risk of partnership and develop viable alternatives in areas where they are unsustainable we won‘t attract the GPs of tomorrow or retain the GPs of today,’ she said.

Read the motion in full:

Conference calls on GPC England to reduce the inherent risks in the current partnership model that are alienating GPs and pushing experienced GPs into early retirement by negotiating with the government to:

(i) introduce a form of Limited Liability into the partnership model for contract holders

(ii) recognise the  financial burden of taking on a partnership by seeking full reimbursement of necessary costs incurred in providing NHS premises

(iii) require NHS England to cover staff redundancy costs in the case of list dispersal

(iv) ensure NHS England is obligated to take over the lease of a collapsed practice and act as a tenant of last resort

(v) introduce a statutory cap to the liability which can befall a contractor who finds themselves in the position of being 'last partner standing'.

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