RCGP - Changing Partnerships - 19 March 09
Source
The RCGP has released a new discussion paper that examines the increasing lack of partnership opportunities for GPs in the UK.
Written by RCGP Vice Chair Clare Gerada, ‘Changing Partnerships’ questions whether the shifting employment landscape will ultimately diminish the role of the GP in the UK and lead to fewer candidates choosing general practice as a career.
Until the late 1990s a partnership arrangement with doctors working as self-employed contractors was the norm, but the recent rise of salaried positions among younger GPs has led to concerns over the future continuity and quality of patient care, and specifically doctors’ personal and financial commitment to their work in the community.
Introduction
It is reported that there are now over a hundred applications for each advertised partnership1 and in 2008 it is unusual to see a partnership being advertised at all; the vast majority of new positions are for salaried options only.
Is this lack of partnerships just a passing stage in a cycle of general practitioner (GP) workforce or a continuing, inexorable process that began with the 1990 reforms and accelerated with the new General Medical Services (GMS) contract? Will the change in configuration of general practice risk losing the entrepreneurial spirit of GPs and lead to the end of professional autonomy? Or will the current changes bring new opportunities for doctors, patients and the health service? Will the general practice of the future be run by a small number of corporate GPs and/or private sector organisations? And will it employ a much larger workforce of doctors, nurses and other health professionals within tightly controlled structures – analogous to the Health Maintenance Organisations found in the United States?
If the future entails smaller and slimmer partnerships containing more salaried positions, does it matter? For decades the profession has been fighting for greater flexibility in its working practices, which some argue is addressed by the salaried option. There is also a view, growing in support, that the profession should move away from the small-business ‘partnership’ model and instead work within larger primary care organisations and networks.
This paper will attempt to explore what partnership is, the forces that are driving the loss of partnerships in general practice and some of the issues that this may herald for our profession. Finally, it will end with some recommendations as to what we, the Royal College of General Practitioners (RCGP), should be doing to address this new and rapidly growing salaried workforce of GPs.
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