Partnership model will survive but slump not over yet, warns RCGP chair-elect

The number of GPs in partnership roles across the UK will continue to decline from current levels - but the long-term future of the model is secure, the incoming chair of the RCGP has predicted.

RCGP chair-elect Professor Martin Marshall (Photo: Grainge Photography/RCGP)
RCGP chair-elect Professor Martin Marshall (Photo: Grainge Photography/RCGP)

Professor Martin Marshall, who will take over from Professor Helen Stokes-Lampard as RCGP chair in November, said he expected the number of GPs entering partnerships would ‘continue to drop a little bit’, with fewer GPs wanting the responsibilities associated with running a practice.

But he insisted the future of the partnership model was positive, saying that policymakers were beginning to see the positives of the system.

Speaking to GPonline, Professor Marshall, who was elected in July, said: ‘When I started in general practice, I'd estimate that about 70-75% of practitioners were partners, but now it’s 55% and I suspect it will continue to drop a little bit...but not massively.

Partnership roles

‘[Now], you’ll see that the people who are interested in running businesses will become partners, rather than everyone believing the ultimate aim is to become a partner.

‘We are supportive of the partnership model [as] we believe it adds real value. We [also] strongly believe that policymakers are starting to understand the cost-effectiveness of the partnership model. I don’t sense any policymakers wanting to get rid of the partnership model.'

The number of GP partners in England fell by almost 3,000 between September 2015 and December 2018, according to official workforce figures published by NHS Digital. As of December 2018, there were 21,620 partners in England, down 12% from 24,521 in September 2015.

The rapid loss of partners reflects a growing pressure on the general practice workforce, with doctors increasingly looking to step away from partnership roles to escape unmanageable workloads.

In the past, becoming a partner had been seen as the natural route of progression for most GPs.

Future for partners

Despite predicting a further decline in partner numbers, Professor Marshall was optimistic about the future of the independent contractor model, saying there was still interest among doctors.

But he insisted that changes were needed to make partnerships more attractive, pointing to recommendations in the GP partnership review published in January.

‘A growing number of junior doctors that I speak to say that they don’t want to be part of [partnerships] now, but they might well consider being a partner in five years’ time,' Professor Marshall said. He added that there are steps the profession can take - including those set out in the review - to encourage GPs to become partners.

‘For example, derisking the role of partnerships, particularly around premises and legal liability, which if those are acted upon will make partnerships much more attractive.’

The RCGP backed the partnership review findings in January, with Professor Stokes-Lampard labelling its advice 'optimistic and pragmatic’. In particular, she praised its focus on reducing unnecessary workload in general practice and increasing both the GP workforce, and the wider practice team.

Primary care networks

Another recommendation of the January review was that primary care networks (PCNs) must help partners to address workload issues.

Although NHS England has said it will look to PCNs to stabilise the partnership model, some GPs have warned they could a negative effect - offering unwanted competition by poaching business-minded GPs for clinical director roles.

But Professor Marshall said the two roles would not conflict, suggesting it was possible to do both.

‘I’m not sure I see any tension there. There are plenty of emerging clinical directors who are partners as well as salaried doctors. I think you can do both perfectly well. I think PCNs are an exciting development with some real potential,’ he said.

The vast majority of GP practices across England have now joined PCNs, which became operational from 1 July. A total of 1,259 PCNs have been set up, and the organisations will be backed by £1.8bn in funding through the five-year GP contract agreement published earlier this year.

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