Tuesday 26 June 2018

Submission to GP Partnership Model Review

Dr Nigel Watson has been appointed to lead an independent review of the GP partnership model. Here is my submission to that review.

There is a danger of conflating the advantages of the GP partnership model with the employment status of GP principals (usually self-employed).

The advantages of GP-owned independently contracted practices include:

  • senior clinicians - GPs - still in clinical practice have responsibility for a population and make decisions for the practice.
  • an unparalleled sense of ownership by GPs and willingness to go the extra mile for practice and patients.
  • remuneration is linked to the performance of the practice.
The potential disadvantages of GP partnership include:
  • unlimited liability (when the viability of a practice is often beyond the control of GPs)
  • lack of clarity/predictability of pay to individual GPs
  • no access to PAYE, childcare vouchers and other benefits of employment.
Most of the advantages of the GP partnership model to the NHS relate to GPs owning their practices. Why must we insist that they are also self-employed?

The ideal model of GP contracting would allow practices to:
  • limit their liability and
  • hold a GMS contract and
  • retain access to the NHS pension scheme for their staff and
  • let them decide for themselves how to contract all of their staff, including GP principals.
For example, a practice could operate as a limited company, include their GP principals as directors, pay all staff (including GP principals) a basic salary. Staff could be awarded or allowed to buy shares in the practice, on the basis of which they might receive dividends and/or voting rights. Whilst current GP principals might hold most of these shares, sharing them with currently salaried GPs if not other staff also would be a way of re-engaging them and giving them a greater sense of ownership.

Notes from RCGP Council meeting 23 June 2018

Highlights from this meeting included the following.

A new vision for General Practice

A draft paper on the future role of GPs.

Person Centred Care

This approach, which RCGP has been developing since 2012, revolves around the maintenance of a written care plan for each patient as part of a collaborative partnership between patient and health professional, not least to help patients identify resources within themselves and their community to manage their wellbeing.

It was suggested that the language used was unhelpful, implying disempowerment of both doctors, who must provide whatever patients need, and patients as passive recipients of care, which is presumably the opposite of that intended.

Challenges were also made to the recommendation for social prescribing by doctors. [There is insufficient evidence that it is successful or value for money.] It was suggested that doctors should instead only do that which a medical licence is required for.

Urgent and Out-of-Hours Care

Tentative suggestions that all GPs should regularly undertake some out of hours work were not welcomed.

Sponsorship consultation

A consultation is underway to reframe RCGP's policy on accepting sponsorship. Please share your views with your Faculty board as a matter if urgency.

I thanked the Chair of trustees for taking on feedback from myself and others in designing this consultation but observed that some respondents are still finding the survey confusing. Some Faculties are asking board members to respond individually, rather than provide a single consensus answer as would apparently be preferred. I asked how we would ensure that the votes of Faculties are weighted according to their size rather than the number of responses.

I noted that the Hon. Secretaries must be grateful to have had help in administering this consultation but suggested that the Chair of trustees, inscrutable as he no doubt is, might have an interest in preserving the status quo and therefore in future it might be preferable to allow the Hon. Secretaries to coordinate consultations on behalf of the trustee board, as they do for other RCGP consultations.