View from the ground by Dr Kenneth Lim
With a month to go, I am about to emerge from my GP training scheme as a newly qualified GP (NQGP). Having thought about my future, I already planned a month of locum shifts before settling down in a salaried GP post. Raising a young family with two children does not give me the luxury of dawdling when finding jobs, so I gave my CV a fresh makeover and fired it off to various practices that required a long-term salaried GP.
During my job search, interviewers would always ask: ‘Would you consider becoming a partner now?’ My answer was always ‘Probably not’, which was always met with looks of sad resignation. The truth is, less than one quarter of NQGPs want to become partners and certainly in my own vocational training scheme (VTS) group of 16 trainees, no one intends to become a partner in the next 3 to 5 years. Given that practices around the UK are struggling to recruit doctors to fill vacant posts and that one fifth of practices spend more than a year recruiting a new partner, it is not hard to see that these figures pose a problem for the continuation of GP services in many parts of the country.
There are four main reasons why I see partnerships as undesirable among NQGPs. Firstly, as trainees we have seen and heard of the general lack of morale among current GP partners. With threats of mass resignations and early retirements, the prospect of partnership does not inspire us or fill us with hope for a stable and sustainable way of life. Secondly, although the Government has promised a further £2.4 billion per year in investment for primary care, no one is really sure how or when the money is going to be distributed. With falling profits and uncertain incomes for partners, NQGPs prefer the stability a salaried GP post offers, or the assured pay rates of a locum doctor.
The third reason would be the lack of leadership and business management training; I can only recall one lecture from my VTS educational sessions that dealt with the intricacies of accounting. To add to this, no one has specifically explained what being a partner involves or how partners earn their pay. It is no surprise then that the majority of my peers see partners as being shrouded in mystery as they recede behind closed doors when a practice meeting is held. How do you run a profitable business? What does it mean to buy into a partnership? These questions would have been better addressed within our training years if the RCGP curriculum had included business management (which it does not).
Lastly, we fear that the current independent contractor model that most GPs have run since the inception of a primary healthcare service is in peril. Whole practices have opted to hand back their contracts and convert to a salaried model; other GP partners have chosen to resign and work as locum doctors. Who can blame them? The Government has set its heart on corralling GPs into a tight corner, controlling how they work and how much they earn. With such prospects, it is no wonder that NQGPs are shunning partnership jobs.
At the end of the day, most NQGPs are highly skilled and motivated to serve their communities and hone their craft. They will adapt to the ever-shifting sands of the political landscape. However, if we are to entice more GPs to become partners, there has to be a change in both the culture and politics of general practice. If we can improve trainees’ understanding of managing a business and guarantee that the money invested in general practice makes partnerships sustainable, we will see our profession flourish again; and that can only be good for the patients we serve.