23 Oct GP partnerships have much to offer the transforming NHS
The likely demise of partnership-based general practice has been predicted so often in recent years that, in line with the adage about constant repetition, it is in danger of being regarded as the truth.
There are certainly challenges. The role of general practitioner partner has become less attractive to doctors who are concerned about the pressures of running a practice as well as managing an increasing clinical workload. In future, partners will need to lead change too, because the ‘corner shop’ model of independent small practices does not align with the need for greater integration of care provision.
One consequence of the present approach has been minimal influence over how local health systems are run, because there are no representatives who can interact with system leaders and speak on behalf of more than their own practice. This lack of involvement will be detrimental as the new models of care will impact significantly on the day to day working of the typical local surgery.
The developing large scale GP providers can certainly address the challenges of system representation and influence, as well as provide support to practices, but is it necessary to throw the baby out with the bath water and start employing GPs at the same time? It is hard to see how the NHS Trust approach, for example, offers a solution to the challenges faced by general practice?
Most Trusts are currently struggling in the face of severe performance challenges, and as a result they are losing autonomy and increasingly subject to external regulatory drive. We know that in these circumstances staff morale and engagement tends to decrease, so it is difficult to see how creating similar organisations to provide general practice, or indeed incorporating general practice into existing Trusts, could energise GPs and create the improved conditions required in general practice?
As the Forward View is implemented and the service is transformed, we expect a less competitive culture to emerge in which system considerations will take precedence over institutional interests. Any new GP organisations should therefore be forward looking, and built on the principles of collaboration, partnering, and engagement, as well as working to ensure the GP role is a rewarding one.
Since forming Our Health Partnership, we have been clear this is a partnership and not a hierarchical organisation, very different from the NHS Trust model. Board partners are elected, including the Chair, and the executive are employed by the partners and accountable to them. There is a single tier of 180 partners, who own the organisation, so those elected to the board are genuinely ‘first amongst equals’.
The powers of the board are limited, and tightly defined in the Partnership Deed, which keeps as much decision-making as possible at practice level. This nurtures the ownership, engagement, and sense of common purpose that are inherent features of a partnership. They are also critical success factors for any healthcare provider, and moving to an employed model may put them at risk.
What about service quality? Health leaders in all sectors know this is best achieved by embedding responsibility, and accountability, for quality with front line clinicians and their teams. In a centrally driven organisation, this is often challenging. In partnership general practice, it is fundamental. In OHP, we believe our system of autonomous practices led by locally-based partners is the right one to deliver high quality care that is responsive to local community needs.
We are starting to understand that large GP providers can be created without losing what is valued, and valuable, about the partnership model. If large partnerships prove able to relieve some of the pressure on partners, the role will become attractive again. The prize is to create manageable jobs that allow doctors to maximise clinical time, retain control over local service delivery, enjoy the support of like-minded colleagues, and influence the transformation of their local health system.
In the coming period we should be moving towards high trust, collaborative, non-hierarchical provider structures, because they engage staff and build a strong sense of common purpose. The partnership model of general practice can easily be adapted to support greater care integration and, if supported, can form a critical part of the future provider landscape.