Overhaul pensions and limit financial risk to boost partnerships, says review

Pension rules must change to stop 'perverse incentives' for GPs to cut working hours, and practices should be allowed to hold contracts under a limited liability partnership or mutual model to limit personal financial risk for partners, a major review has concluded.

GP part

GP partners must also be offered better protection from liability for premises costs, according to the GP parnership review led by Wessex LMCs chief executive Dr Nigel Watson.

The review highlights 'significant opportunities that should be taken forward to reduce the personal risk and unlimited liability currently associated with GP partnerships', warning that the model 'could be lost' without steps to retain existing partners and to bring in new ones.

GPC chair Dr Richard Vautrey welcomed the review, and said it provided 'clear backing at the highest level to the partnership model as the best way of delivering what most patients want – and that is good quality continuity of care delivered by a locally-based team, embedded within their community, who they know and trust'.

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Read the key partnership review recommendations in full

The review warns that many partners who lease premises fear that if they are forced to hand back their contract, they could be left with full financial liability for a lease with many years still to pay. It calls for a 'more comprehensive assignment clause to leases where premises are required to be "fit for the future" and required for the delivery of primary care'.

The measure could help tackle GPs' fears of being left as the 'last person standing' in a practice - a problem that Dr Vautrey warned last year was 'fundamentally undermining the partnership model of working'. The review also calls for advice from NHS England and the GPC on how practices can 'separate property ownership from other aspects of the partnership model'.

Echoing a warning in an interim report published last year, the review warns that many GPs now believe the risks associated with taking on a partnership role significantly outweigh the benefits.

It backs legislation to allow GMS and PMS contracts to be held by GPs operating under different business models that would protect them from unlimited personal liability - such as limited liability partnerships or mutuals.

Business models

However, the review acknowledges that these models may force practices to publish accounts or other corporate information, and warns that switching to a new legal structure may open up contracts to competitive tendering. It calls for a 'rapid piece of focused work' by the DHSC over the coming six months to clarify the legal implications of these models and 'allow the removal of any unjustified restrictions'.

The review demands an overhaul of pension arrangements for GPs, warning that changes to the annual allowance and lifetime allowance in recent years have had a 'significant impact on GPs'.

It found that many GPs - even at fairly early stages of their career - were reducing their clinical work, taking early retirement or quitting the NHS pension scheme because of 'perverse incentives' created by increased tax charges.

The GP partnership review recommendations also build on plans set out in the NHS long-term plan for contractual arrangements to move all practices into primary care networks. It calls for multi-professional community health teams to be based in and directed by primary care networks.

Primary care networks

These teams should be co-located with their networks where possible, 'closely partnered with and embedded in practices day to day'. This would create a 'single team using a common health record, sharing the same caseload and removing the need for referrals', the review says.

It also calls for primary care networks to be designed to improve practice sustainability, and to take control of funding for extended opening and access - handing GPs a greater role in managing demand.

Dr Vautrey said: 'The partnership model is the backbone of general practice and is what has given it its strength and resilience, providing the foundation to the NHS for the last 70 years.

'The model, which gives practices the autonomy and independence to innovate while building quality relationships with people in their local community and being able to advocate on their behalf, is why both patients and the CQC continue to rate general practice so highly.'

He pointed to increasing pressure on GP practices, and concerns raised about growing risks for partners, warning: 'It is imperative that the government takes these seriously, from backing changes to indemnity to coming forward with tangible proposals to reducing the risks inherent in owning and leasing practice premises.'

Dr Vautrey added: 'One key area – the significance of which cannot be underestimated - is the current workforce crisis. The number of full-time GP partners in England continues to fall as they struggle with workload pressures, and without enough doctors both the sustainability of the partnership model and the quality of care offered to patients are in jeopardy.'

The GPC chair said he was ready to work with NHS leaders to implement proposals set out in the review, but warned there was 'no miracle cure or panacea'.

Beccy Baird, senior fellow at the King’s Fund think tank, said: 'The NHS long-term plan places general practice at the heart of improvements to the health service. If that ambition is to be met, then general practice should be provided with support and training in leadership, management and organisational development, and it will need to be central to integrated system plans.’

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