One of our well-established partners has become involved in the local CCG. By mutual agreement, this was for four sessions a week, with the practice covering for her absence with locums and seeing more patients.
She keeps the remuneration and has taken a proportional reduction in income share. Increasingly, there are problems with her absence, with disputes over whether she should do all of the insurance reports and medicals requested by her patients, how many visits she does and patients grumbling about never being able to get an appointment.
We want her to stop her CCG work, but she says she has a three-year contract that she must fulfil. Where do we go from here?
A GP's response
Dr Kamilla Porter is a GP in Rochford, Essex
This scenario raises questions about partners' workload planning, the provision of adequate appointments, possible professional jealousy and realistic expectations about how much work an individual GP can take on.
Answering these questions satisfactorily and obtaining a constructive outcome will require an open and honest dialogue with all of the partners, otherwise a messy partnership dispute may result.
In the first instance, the practice manager could undertake an objective analysis of appointment availability and demand, to assess whether appointments have indeed gone down since the partner took on her CCG role. If the other partners are doing more work, the next step would be to arrange a practice meeting to discuss this. To mitigate any ill feeling, it might be helpful first to acknowledge some of the positive aspects about this partner's involvement in her local CCG:
- Her position may raise the profile of the practice.
- Staff can share ideas directly with her about providing better patient services.
- Her regular feedback to the practice about important local developments and any service change is welcome.
- Her considerable experience as a well-established partner should help her to play an important and constructive part in the CCG, to enable local GPs to deliver better care and improve services.
Next, you could ask her how she is coping with her various professional roles. Has she overcommitted herself, could she be at risk of burnout?
However, while her role in the 'bigger picture' might be appreciated, it is important to convey the impact this is having on the practice and the rest of the partners.
Share the data on patient appointments and the 'grumbling' from her patients and move on to discuss how best to address this. Options to put on the table might include:
- Taking on a part-time salaried GP, or even a part-time partner (who would be able to cover the insurance reports and medicals) or a nurse practitioner. Would these options be more efficient than covering four sessions a week with locums?
- Could payment for a salaried doctor or partner be covered by her reduction in income share, or would a compromise be for some of her CCG remuneration to be invested back into the practice?
- Ensuring her regular patients are aware that her surgeries have reduced, for example, by explaining her CCG role in the practice newsletter and on the website.
- Drawing up a job description for her days at the surgery, so that she and all of the partners feel their workload is distributed fairly and equitably.
This GP has been a partner at the surgery for a while and deserves an opportunity to discuss how her two professional commitments could prove successful if changes are made, rather than just telling her to quit.
Traditionalists may bemoan the rise of the portfolio GP, but with the current NHS reforms and workforce changes, many GPs will no longer be in the practice every working day.
With good planning and communication among the whole practice team, it should still be possible for GP surgeries to function well with a part-time partner.
A patient's opinion
Elizabeth Brain is an expert patient
It seems the work of being a member of the CCG is either more extensive than the GP foresaw, or else she is doing more than her contract with the CCG requires. Perhaps she simply finds the role more interesting than her partnership in the practice.
Being a practice partner, she has a duty to her colleagues to explain why her involvement is taking more time than was originally agreed and to propose what options might be available to resolve the situation.
She should be asked to attend a meeting with all of her colleagues, perhaps facilitated by the practice manager.
While the GP should be made fully aware of the impact this is having on her patients, the emphasis should be on resolution rather than confrontation, and the meeting should be held in an atmosphere of mutual respect and understanding.
Should this approach fail, the following might be considered. The practice could recognise that the work she is doing will contribute to the greater good of the practice and its patients in the longer term and therefore, if budgets allow, concede to her needs and make up the shortfall by increasing the number of hours of locum provision.
Alternatively, the practice could insist she adheres to the 'mutual agreement' by cutting back her CCG activities, or that she leaves the practice. This does risk her opting for the latter and might lead to considerable complications for her, unless she joins a practice in the same local authority area, and for the practice.
A GP trainer's view
Dr Alison Glenesk is a GP trainer in Aberdeen
This practice has certainly got itself into a difficult situation.
It is hard to imagine why the partners have agreed to do more work to cover this GP's absence, particularly as they do not seem to be deriving any benefit, assuming that their partner's reduced share will be eaten up in locum costs.
Generally speaking, when a partner takes on outside work, the remuneration is used to pay for locum cover.
However, in this case, the partner has actually reduced her partnership share, so she can only be expected to work pro rata.
It is also well recognised that even the most diligent locum, by virtue of being in a salaried position, will never fully replace a partner. Add to this the fact that this arrangement is due to last three years, and we can see that they have not really thought things through realistically. So what to do now?
The partner has reduced her partnership share to take on this job, with the full consent of the other GPs. She is now part-time in the practice and can only be expected to take on this proportion of the work.
Allocation of reports and medicals should be according to the practice's existing policy.
Asking the partner to leave her commissioning post or reduce her number of sessions seems somewhat unfair, because she has reduced her partnership share with the full consent of the other GPs. She will also now be under contract to the CCG, so the problem is not hers to solve.
Situations such as this can destroy partnerships and discussions tend to become acrimonious. The most sensible next step is to arrange some outside mediation to assist with negotiating a mutually acceptable solution; we have found the BMA very helpful in the past in dealing with matters such as these.
It would also be worthwhile for the partner in question to contact her defence union for further advice about her contract. Most importantly, the practice should also develop a policy for dealing with future such requests from partners.
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