The final report of the GP partnership review is the culmination of a thoughtful process led by Dr Nigel Watson for the DHSC and outlines a range of recommendations aimed at reinvigorating the partnership model.
The partnership model has been at the heart of general practice since before the creation of the NHS and has been widely agreed to be an effective model, with its ability to harness innovation, to give autonomy to local leaders to be rooted in local communities to provide value for money. But it has been changing.
What was a cottage industry in the 1950s has over the decades evolved into a complex web of different organisational models and general practice has evolved from single practitioners to multidisciplinary enterprises. At the same time, partnership appears to have become less attractive to GPs, with many practices struggling to recruit to vacancies for partners.
More on the GP partnership review
> Overhaul pensions and limit financial risk, says review
> No future for GP partnerships without urgent change, warns review
> Partnership review backs early-career incentives to boost workforce
There are wider issues at play here which the review points to. GP workload has been rising in volume and intensity in recent years and at the same time the number of GPs has been declining.
This has led to a feeling that workload is unsustainable and GPs are seeking to protect themselves from burnout, limiting the days they are willing to work in patient facing general practice and choosing salaried roles rather than partnership. A survey of GP trainees that we carried out at The King’s Fund last year found that only 37% of them wanted to take on a partnership, largely because of workload pressures.
The review addresses and makes recommendations some of the key technical issues which might be contributing to GPs choosing not to become partners, particularly to reduce the personal risk and unlimited liability related to the partnership model. It points to the £4.5bn of investment in primary and community services outlined in the NHS long-term plan.
There’ll be more sense of how much of this investment will go to general practice once the outcome of the GP contract negotiations is known next month but a shift of resources to primary care is welcome.
NHS long-term plan
The long-term plan and the partnership review set much store by the creation of primary care networks – groups of neighbouring practices covering populations of 30,000 to 50,000 populations as a vehicle for this money.
There are advantages to collaboration, but I have concerns that the scale of ambition for these networks does not necessarily take account of what the evidence says about what makes collaboration in primary care work. General practice will need significant support and training in relationship building, management and organisational development if it is to really achieve the ambition set for it.
I think the review is a useful first step, but points to lots of other issues that will need to be addressed if the partnership model is to be truly sustainable. Some of these are more technical, such as pensions and estates, both issues for which there are unlikely to be short-term fixes.
For me, the biggest single issue in ensuring the partnership model remains viable is tackling unsustainable increases in the volume and intensity of GPs’ workload. That is going to require a credible national workforce strategy which addresses gaps in the numbers and skills mix of staff needed to support general practice.
- Beccy Baird is a senior fellow at The King’s Fund