Most professional businesses, accountants, lawyers and the like practice as partnerships - some as LLPs (basically partnerships with limited liability) and some not. We don't do this out of habit, nor out of dogma, but because the partnership model is an extremely efficient model.
In the case of GPs, the GP partner is the clinician, manages the property, HR, finance and ensures the surgery keeps open.
The average GP partners earns profits of around £130,000 which is £114,000 after excluding the employer's superannuation, and works around 50 hours per week.
A salaried GP working 10 sessions probably works 37 hours per week, and at £9,000 per session earns £90,000, while the same partner earns £114,000 for 50 hours. In other words, the salaried GP earns £46 per hour while the partner earns £43 per hour. Sounds efficient to me.
Yet despite this, the GP partnership has been called into question by NHS England's top GP.
The other point that has to be made is that the current GP partnership model actually works. What is it with the NHS that it insists on bringing in innovations that work less well than before? Local area teams of NHS England are undoubtedly less efficient than the PCTs that went before, new post-April 2014 global sums don't work, and neither did the 2004 changes.
I agree that GP partnerships are struggling, but not because the model of operation is flawed, but for other reasons.
PMS and GMS contracts provide for a long-term commitment from both the GP partnership and the commissioner. Practices can invest for the long term, they can borrow money if necessary, recruit staff for the long term, all of these are questionable if the GP has a short-term APMS contract. The current concern that APMS contracts are not as efficient is because their short life undermines them. And predictably, the contracts that work are no longer on offer, just those that don't
GP partnerships are struggling because they cannot recruit GPs. This is not news.
GP partners are generally fed up with being dictated to, undermined, underpaid and undervalued and many look to get out at the earliest opportunity.
Blaming the partnership model, which has worked so well in the past and continues to work well for other professions who are free from interference is foolish. It is not the partnership model that is flawed it is the environment and psyche that undermines GPs at every opportunity
Just in case anyone making decisions in Whitehall hasn't noticed, while there is a crises in finding GPs, there is a host of talented recently retired GPs who could fill a number of gaps. Having driven them into retirement, why not think about incentivising them to come back and help out? How about tax free golden hellos, revalidation-lite, how about valuing what you have
It is not the partnership model that is broken, but almost everything else is.
- Laurence Slavin is a partner with Ramsay Brown and Partners Chartered Accountants who specialise in the finances of GPs.