'Without change, partnerships will die,' warns Dr Nigel Watson, the independent chair of a review tasked by former health secretary Jeremy Hunt with pinpointing ways to revitalise the partnership model of general practice.
Eight months after he was appointed to lead the review, the New Forest GP is speaking to GPonline as the NHS prepares to publish a report setting out his findings.
He is clear that doing nothing is not an option - with the well-documented pressures forcing practice closures to record levels and GPs to quit partnership roles in droves already leading to widening health inequalities and putting patient health at risk in parts of England.
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Seven key points set out in the review - distilled from scores of visits to practices, meetings, debates and consultation responses over the past eight months - highlight the need to reduce risk for partners, boost GP and practice staff numbers, and expand the range of services available in and around general practice.
The review calls for more GP-focused medical training, designed to help young doctors understand partnerships and the role they play in the wider health service. It also backs primary care networks to support member practices, representation of GPs at the top of the health service and better access to technology.
Despite its grim warning that 'the future looks bleak for general practice unless action is taken now', Dr Watson says he feels 'considerably more hopeful' having completed the review.
Quick wins
The partnership review chair says some proposals could be fast-tracked to bring much-needed relief to GPs rapidly. Proposals to protect GPs left as the 'last person standing' are among these.
Changes backed by the review that Dr Watson believes could be implemented quickly include measures protect GPs from the financial risk attached to long-term practice lease agreements, and changes to reduce personal financial risk for partners by allowing limited liability companies or potentially mutual-style organisations to hold contracts.
The state-backed indemnity scheme due to begin from April must also bring sustainable protection against clinical negligence costs 'without undermining the financial stability of a practice', the review warns.
Meanwhile, the NHS long-term plan published last week explicitly backed proposals in the review for a 'fellowship' scheme to introduce young GPs to partnership roles, and the national review backs the rollout of primary care networks - a measure the review says can make practices 'more sustainable'.
Government support
Dr Watson admits that whether the government will back his plans remains the '£64m-dollar question'. Neither will he take the profession's support for granted - although he says feedback suggests the proposals are focused on many key areas of concern.
But he says: 'I could have come up with a long list of wishes that would not have got support and been almost a waste of time. These have been crafted to make a difference to the delivery of general practice at the coalface but also to try to make sure they are things we think NHS England would support and implement.
'I have been working with the DHSC, NHS England and the GPC - the recommendations have gone in, we have met Treasury officials and others. Nothing we have said will surprise them.'
He is hopeful that the recommendations can form the basis of a 'clear roadmap for general practice' - pointing out that it is vital that GP practices and primary care are ready for the £4.5bn additional investment over five years promised through the NHS long-term plan.
Partnership risks
Dr Watson says there is no single recommendation in the review that is the most important. 'That is part of the challenge. If there was a silver bullet, we’d have found it.
'If you talk to doctors leaving the profession and to those joining it, the risk associated with partnerships is perceived as much greater than the benefits, so why would you be a partner? People say they still like being a GP, but are being forced out or cutting sessions due to stress and burnout.'
Dr Watson says that he hopes GPs will 'read the review and feel positive' - and see elements that reflect their own experience and offer solutions that can make a difference.
The review concludes that 'significant additional resources are required, which must go to the practices and localities that develop services and the workforce needed to manage demand.'
It adds: 'Doing nothing cannot be an option. The consequences would be clear - the widening of health inequalities, with areas of the country where general practice will struggle to continue, the inevitable rise in pressure and costs in the rest of the health and care system, worsening clinical outcomes, and falling patient trust in the NHS.'
