Never before in the history of the NHS has there been the same opportunity for entrepreneurial GPs to develop their practices.
But it would be unwise to ignore the opposite side of the coin, namely the threats that stand alongside. And what represents an opportunity for one practice may become a threat to its neighbour.
At a time when there is less stability to be derived from a GMS or, particularly, a PMS contract, and as relationships between the profession and primary care organisations (PCOs) become stretched, it is ever more essential for each practice to give itself a health check.
You need to ensure that your practice is positioned as strongly as possible to enable it to compete against, or to join forces with, rival bidders and so thrive - or even survive.
Basis for agreement
This requires a close look at the internal structures and stability of the practice itself, otherwise the weakest links might find themselves facing a relatively rapid 'goodbye' from either the PCO or others with whom they might seek to develop new opportunities.
The glue which sticks together the constituent members of any partnership has to be the partnership agreement, not only because of the legal effect of the agreement itself, but because of the process the partners are bound to undertake in order to sign up.
By that stage all the more sensitive issues, which might otherwise be swept under the carpet only to re-emerge at a moment of crisis, should have been thrashed out and resolved.
Furthermore, a well-drafted partnership agreement should prevent either an individual, or group of partners, from seeking to dissolve the partnership on a whim in order to serve their own purposes.
Not only does this prevent the general disruption which results from dissolution but, more significantly, it avoids the possibility of the PCO stepping in and taking the opportunity to seize the contract.
A well-functioning partnership should operate from a position of balance. One of the most significant clauses to consider including in agreements for partnerships of four or more is a 'Green Socks' clause.
This enables the partners to eject a partner in their midst who might not have done anything wrong, but who simply no longer fits in with the ethos of the others. It may be for something as simple as wearing green socks, hence the name of the clause.
If he has become 'a square peg in a round hole' it is for the good of everyone that he seeks to find another practice of 'square pegs'. However, before that stage is reached, the mere existence of such a clause in the agreement can assist in retaining the essential balance.
Of course, quite apart from having something agreed on paper, it has to work in practice. The business itself has to function.
There has been a growing trend since the advent of the new GMS contract for partners to believe that a practice can be effectively run by diminishing numbers of principals.
The new regulations do, of course, permit this and there is a temptation to retain the additional profits available upon a partner's retirement and appoint less costly clinicians or managers to take over their day-to-day function.
However, while this might work to an extent, it is important to identify the point at which the balance of the scales tips, thus exposing the entire structure and stability of the practice itself.
Whereas four partners might have been able to cope reasonably happily, the reduction of that number by one, coupled with a partner on holiday and possibly another on long-term sick leave, can soon upset the applecart.
With so many pressures upon GPs these days, the additional income to be derived from an extra share may, with the benefit of hindsight, appear insufficient compensation for the problems that subsequently appear.
If GP practices are to survive, let alone thrive, in the competitive marketplace in which they now find themselves, it is absolutely crucial to ensure that the underlying scaffolding is in place, lest the slightest puff of wind from a competitor should cause the entire structure to collapse.
Lynne Abbess is a medical specialist partner at solicitors Hempsons
KEY POINTS TO CONSIDER
You need to ensure that:
- Your business functions effectively and efficiently.
- The partners are of like mind.
- You maintain an up-to-date partnership agreement.
- Your practice is attractive to others in order to maximise