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.