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Is GP Partnership for me? 10 questions to ask yourself
If you are considering GP Partnership or wondering if you would make a good GP Partner, then this is a must read by guest blogger Dr Kunal Chawathey!
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Until a decade ago, becoming a partner was the usual career path for a GP. This is no longer the case, with many reasons accounting for the drop in its popularity. There are however still many thriving partnerships in the country with over 17,000 GPs in partnership positions (as of June 2021).
Partnerships can be complicated, and it is therefore important to do your groundwork before accepting a partnership offer. By far the most important question that you must ask yourself – both at the outset, and once again when you have enhanced your understanding of the pros and cons of being a partner is, ‘What is it that draws me towards partnerships’. Some of the factors that make partnerships attractive include: a stable source of income, sense of achievement, contribution to the community, respect from local community, ability to make changes, having a multifaceted career and a greater control over one’s life and work. However, all these are not without risks and sacrifices; the nature of the beast is such that one must make their decision based on how relevant each of these factors are for themselves. It is therefore important before taking the plunge to be aware of the reality of partnerships in current times as well as the specifics of a partnership on offer.
With this in mind, let us consider the important questions to ask before entering into a partnership.
Impact on the community: ‘Do I want to focus primarily on medical care, or do I wish to play a greater part in the health and wellbeing of the community I serve?’
As a partner, you would be able to influence care provision to the local population far beyond the GMS (General Medical Services) contract. This is not restricted to speciality community clinics and local enhanced services, but also lifestyle promotion through activities such as educational sessions for chronic conditions, community walks, park runs, liaising with local gyms etc. It does mean that you will work beyond your clinical hours to make these happen, but the level of work satisfaction will be high.
The inevitable portfolio role: ‘Do I want a multifaceted career?’
GP Partners are not just clinicians. They are also managers, employers, educators and entrepreneurs. Most partners will develop interests in the domains of clinical care, education and management. Some of the popular areas are minor surgery, joint injections, women’s health, rheumatology, dermatology, undergraduate & post graduate teaching, business management, involvement with the local medical committee & the CCG etc. As a partner, you will invariably take on a few of these roles.
Autonomy: ‘How important is it for me to be able to do things my way?’
Although the government tries to micromanage, the GP partner is still the captain of the ship and has the autonomy to steer it. As a partner, you can decide how clinics are set up, design triage system, decide staffing requirements etc. So long as you are working within the contractual framework, you retain the autonomy for in-house decision making.
Financial aspect: ‘Does the additional income make it worthwhile for me?’
Partnerships are small (to medium sized) businesses, and your earning depends on how well you run the business. In general, partners earn more than salaried GPs, but the gap is closing – and this is one of the reasons why many GPs choose to be salaried than take on partnerships. Over years there has been clamping of incentives to partners such as removal of seniority payments, reimbursements not in line with inflation, rising staff salaries, and the ever-increasing amount of workload that is diverted from secondary care into community without sufficient renumeration. Before accepting a partnership, it is important to look at partnership accounts over the previous years and consult an accountant (or experienced GP partners) who can provide an unbiased opinions.
Financial liability: ‘Am I prepared to take the financial risk?’
GP partnerships operate, in most cases, as unlimited liability partnerships. This means that in the unfortunate event of practice closure, redundancy payments will have to be made at the cost of personal assets. Many GPs entering into partnerships are unaware of this!
Medicolegal liability: ‘Am I prepared to take the medicolegal risk?’
As a partner, you have the overarching responsibility of managing the clinical workload. As the workload increases, partners are the ones dealing with the pressures.
Practice premises: ‘What about premises?’
Ownership of premises is a complex issue and one that is unique to each partnership. Practices receive some form of rent from the local authority (such as notional rent or cost rent), which usually balance out mortgage payments and allow equity to build over time. Practices have agreements in place with regards to buying in and how rental income is dispersed. In some practices, the premises are owned by the local authority. If you are not keen in having a property investment, you could choose a partnership that does not own the premises.
Other responsibilities: ‘Am I really interested in running a business?’
Running a business means ensuring that your practice finances are sound, premises are up to required standards, CQC requirements are met, all policies are up to date, staff issues that crop up quite regularly are managed appropriately etc. The list goes on and on.
Interpersonal relationships: ‘Do I get along with other partners?’
If a marriage can be challenging at times, imagine interacting with the partners in your partnership on a regular basis, settling differences of opinions amicably, debate over issues at meetings, deal with conflicts in a healthy manner etc. Interpersonal relationships are unique in each partnership, with varying amounts of team spirit, friendliness, ‘social distancing’, and animosity in some cases. It would be a mistake to jump into a partnership (as it would, in case of a marriage) without being certain that you get along with your partners to-be.
Types of partnerships: ‘What type of partnership suits me?’
Partnerships can be single handed (not popular anymore, due to the high work pressures and unlimited liability), medium sized partnerships with approximately 4-8 partners catering to 7000 -15000 patients, and super partnerships that own multiple premises under one umbrella partnership. The latter are safer from a liability perspective, but at the cost to autonomy. Most practices are now a part of a local care network, working together towards the common goal of delivering high quality patient case whilst retaining autonomy for the individual practices.
Dr. Kunal Chawathey MRCGP, DRCOG, Dip. CBT, MBBS
Partner, Wychall Lane Surgery
Finalist UK GP Awards, Diabetes care (2018)
Editor, Crammers Corner, InnovAiT
GP Trainer, West Midlands Deanery
CBM Tutor, University of Birmingham Medical School and Aston Medical School
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