The General Practice Blog Archives - Page 70 of 83

jul

What GPs should consider if they are thinking about partnership

Posted by Ben GowlandBlogs, The General Practice BlogNo Comments

If you are a GP who is thinking about becoming a partner, what questions should you ask to be sure you are making the right decision? In this guest blog (his third for Ockham) mergers expert Robert McCartney introduces a checklist of things you should consider to help you make the right choice. You can download and print off the checklist following the link beneath the blog.

We undertake a lot of work assisting practices in developing plans for the future and redesigning systems which strengthen general practice. However, much of this work is undermined by the simple fact that there are insufficient numbers of GPs willing to be partners.

Exploring this with a range of junior, salaried and locum GPs it has become evident that the biggest issue is a lack of understanding about the potential benefits and opportunities partnership still offers.

Work must continue to tackle the issues facing general practice but, at the same time, we need to highlight the positive side and help develop the vision of what general practice could look like if the independent contractor status is secured for future generations.

Feedback highlights that potential GP partners do not know what questions to ask to make an informed choice about the opportunities within practices. The checklist, which we have made available below, has been produced to help those GPs considering partnership for the first time. It is not a complete list but should help structure your thoughts around the type of information you need to know before agreeing to invest in the practice.

As a general point it is recommended that you obtain support and advice throughout the process. The local LMC and trusted GP partners will be able to assist you in identifying when an opportunity is suitable for you.

Entering partnership includes accepting a degree of responsibility for the management and running of the business and you should therefore invest in gaining some simple business skills. It is not necessary to enter onto a MBA course but finding suitable sessions on understanding accounts, HR responsibilities and the principles of leadership will all help you once you enter partnership.

When you are considering the list remember that the final decision will also come down to whether you feel the ‘fit is right’. The culture, relationships and general environment of the practice must suit you or have the ability to develop with you over time. The empirical data collated will give you confidence that you understand the practice but only through spending time and talking with all members of the practice will you be able to make an informed decision.

Download the checklist here.

Robert is Managing Director of McCartney Healthcare Associates Limited. He is an expert on practice mergers and this is the third in a short series of blogs he has written for Ockham Healthcare. If your practice needs a helping hand with its fledgling relationships, you can contact Robert via e-mail at rm@mccartneyhealth.co.uk or call 0203 287 9336.

jul

Guest Blog – GP Partnership: A Salaried GP’s view

Posted by Ben GowlandBlogs, The General Practice BlogNo Comments

Last week Ockham Healthcare hosted an event in central London looking at the rise and fall of the GP partnership model with the aim of encouraging GPs and trainee GPs to consider becoming partners (more information here and a video of the event is available here). One of the attendees was salaried GP Camille Gajria from London who, in a guest blog for us this week, summarises the event and outlines the messages she will be taking away.

On the eve of the NHS’ 70th year, Ockham Healthcare held a live panel event for GPs considering partnership.

GPs chose to be independent contractors when the NHS started. This has often enabled innovation and healthcare tailored to the local population. Although there have been trends towards and away from partnership over the years, currently unprecedented numbers of practices are becoming unviable and closing. So why would anyone want to be a partner now?

Dr Mayur Vibhuti, a GP partner and GP trainer opened by explaining that his role allows him to make tangible improvements to the health of his community. It was interesting to hear how a 7000-patient practice is thriving given the political thrust to work at scale.

Robert McCartney, who runs a primary care mergers consultancy, described practices as community hubs which will always be needed, particularly for people with long-term conditions.

Ockham Healthcare Director, Ben Gowland laid bare the responsibility, risks, and rewards of running a business, including the fact that if the profession became entirely salaried there would be even less control over various aspects of work. He gave a frank explanation on premises and equity- the market shows that GP property is a valuable commodity due to notional rent not being dependent on outcomes, and should ideally be owned by the business. An Ockham podcast published on 10 July has more detail on this.

When choosing a practice, the panel emphasised the importance of finding one with values appropriate to one’s own, identifying risks the practice may be due to face, their plans for the next 5-10 years, and how well they understand their income and expenditure (e.g. do they know at what list size an extra clinical session becomes viable). One point I had previously not considered when looking for a partnership is to assess the relationship with the locality- if one practice is struggling, there would be effects on the others, such as a sudden, unsustainable increase in list size.

There was discussion about how to gain requisite skills for partnership, and where to source help.

The session was expertly chaired by Nish Manek, the National Medical Director’s Clinical Fellow and Teshseen Khan, a Population Health Fellow at NHS Lambeth CCG. They asked and fielded probing questions, both from live and virtual viewers. It was refreshing to have an open discussion about these topics in relation to the current state of general practice, with a diverse and knowledgeable panel and audience.

GPs as independent contractors have been the foundation of the NHS and led innovation throughout its history. Rather than necessarily having to change models to make partnership more attractive, I left feeling GPs need to be conversant with politics, finance, and management, so that we make informed decisions about our roles and the services we run for patients.

jul

Becoming a GP partner – your questions answered

Posted by Ben GowlandBlogs, The General Practice BlogNo Comments

This week’s “blog” is, in fact, a video of last night’s (4th July) live event where an expert panel answered questions on GP partnership. The panel consisted of Ockham Healthcare founder and Director, Ben Gowland, Dr Mayur Vibhuti a GP partner and GP trainer and GP practice mergers expert Robert McCartney. Taking questions from a live audience plus those tweeted in from across the country, the panel discusses the idea of GP partnerships in today’s highly challenged environment for general practice. Should GPs become partners? What makes a good partnership? Should partners own their own premises? What are the risks? How does a partner achieve change with a group of difficult partners? These questions and many more are addressed in this highly topical and unique event…

jun

General practice at the precipice

Posted by Ben GowlandBlogs, The General Practice BlogNo Comments

According to a recent article, in as many as 1500 practices (nearly 20% of all practices) the partners are earning less than the salaried doctors. If this is true (and I have no reason to suspect it is not), then it means the business model that has served general practice for so many years has finally run its course.

If salaried GPs earn can earn more than partners, without the responsibility, risk or workload of being a partner, then there is very little incentive for GPs to become partners. Instead there is a strong incentive for existing partners to become salaried.

But the existing business model requires partners in order to continue. If all GPs choose not to be partners, no one is left running the business. The obsessive focus on the total number of GPs is blinding us to the critical demise in the number of GP partners.

There are two schools of thought as to how this developing crisis should be handled. One is to take the line that GP practices are in fact private businesses, and that the NHS should leave it to the market to resolve the challenges of ownership. If GPs no longer want to run their own businesses, then let’s see who does. This will leave us with a smorgasbord of private providers (Virgin and the like), acute trusts (building on the example in Wolverhampton where the acute trust is now running a number of practices via APMS contracts), community trusts (like the Willow Group, in Gosport, Hampshire), general practice “chains” (such as Modality and Lakeside), alongside general practice operating within the new MCPs and PACS of the new models of care.

Is this the future we want? Attempts to introduce a market to the NHS have not impressed to date, and it is hard to believe this diaspora of provision will serve the population well, and provide a solid foundation for the delivery of transformed out of hospital care.

The second school of thought is that there should be some form of intervention. This would require a clear definition of what current/future sustainable general practice looks like, including the business delivery model, and support provided for this to be delivered. We change the model of general practice in order to make partnership attractive again.

The impact of the GPFV has been limited because it has lacked a clear vision for the future of general practice. It has shied away from defining what the future needs to look like – presumably in an attempt to preserve the autonomy of practices (or even the market) – and has not been brave enough in its delivery of support (practices can choose the bits of support they want from whom they want etc).

This is in stark contrast to the Midlands Health Network in New Zealand. Their response to the challenges facing general practice was a to create a very clear model of care, that included patient call centres, a different skill mix, use of technologies, and improvements to the business model. They recognised the management skills in practice were primarily in operations rather than in transformation, and so they provided support to their member practices to introduce the changes over a six month period.

Helen Parker, one of the local leaders, describes this process in more detail here. They called the programme the Health Care Home and practices have to graduate to become a Health Care Home (they can’t simply decide to be one). The programme is systematically creating a sustainable future for the member practices.

The current model of general practice is at the precipice and hanging on by its fingernails, and it won’t be long before it lets go altogether. Carrying on the way we are now is a default decision to allow the market to decide the future form and structure of general practice. Instead, action is urgently required to create our own version of the Health Care Home, to support practices to implement it, and to preserve and strengthen the general practice service that forms the cornerstone of our NHS.

jun