One of the main arguments for giving up the independent contractor model is that the level of liability it requires partners to take on has become intolerably high.  Partners would be able to sleep much more easily in their beds at night if they were relieved of this burden in a nationalised model.  But is it really such a black and white choice?

Partners of GP practices take on unlimited liability.  This means that the costs of any successful claims against the practice that are not covered by any insurance that is in place will need to be met by the partners.  This includes via the personal funds and assets of the partners, i.e. including their homes and savings.

In recent years the level of exposure for individual partners has gone up.  There are less partners and so the total value of the businesses is divided between fewer individuals, making personal exposure higher.  Property costs have risen, which means as well as the buy-in costs being much higher now than 20 years ago so too are the associated liabilities.  And lurking away in the background is the risk that any individual partner may become the ‘last man standing’ and be left on their own holding all of the practice liabilities.

Then there is the emergence of PCNs.  Partners remain ultimately liable for the extended work that the PCN takes on (unless the PCN has incorporated), as well as for the actions of the much extended workforce with the introduction of the additional roles.

It is no surprise, then, that this level of liability facing individual GP partners is putting many new GPs off from the prospect of becoming a partner.  This is at just the time when the service desperately needs GPs to take on partnership roles.  So surely moving away from the independent contractor model and bringing GPs into the full indemnity protection of the NHS is the obvious solution?

But freedom to operate independently is a function of taking on liability.  If someone else is ultimately liable then it is their prerogative to determine the actions we must take.  Hence the lack of freedom that many hospital clinicians complain about when working in that environment.  The cost of not having the liability is giving up independence.

So is the independence worth it?  The questions for partners to consider is whether they are being properly compensated for the liabilities they are exposing themselves to, and whether they are prepared to give up the freedom that a reduction in their liability would mean?

But it does not have to be quite so black and white.  Outside of general practice things have evolved considerably.  Now when entrepreneurs in this country set up new companies, they do so under the protection of a limited company, which means their liability is always limited to the level of their capital contribution to the firm.   The personal assets of the entrepreneurs are protected.  Now while there are costs and complications of using a limited company model, traditional partnerships in other sectors such as accountants and solicitors have been replaced by limited liability partnerships, where the liability is similarly limited as for limited companies but with less technical complications.

At present limited liability partnerships are not permitted business vehicles for those holding a GMS or PMS contract.  This seems an archaic and unnecessary restriction, and one that it is encouraging to see the incoming Chair of the GPC already being vocal against.  Making technical changes that enable the liabilities that partners face to be in line with those faced by those working in other sectors feels is not just a step in the right direction, but one that is long overdue.

The level of liability that partners of GP practices are currently faced with is too great.  It is a problem that needs to be addressed, both to support existing partners and to make the profession more attractive to potential new entrants.  The most obvious solution is to enable GP practices to become limited liability partnerships.  A far less obvious solution, and one that would be both more expensive and disruptive to implement, would be to nationalise the service, and it makes no sense for the liability issue to be the main driver for such a move.