• GPs are unwilling to take on the personal liability and extra effort of a practice when fee-generated income is falling
• New data protection laws have triggered a surge of subject access requests (SARs) from patients, therefore increasing the workload for practices
• Possible remedies include guaranteed salaries, a loan for premises or a move towards a free market system

The GP partnership is a model of primary care that predates the NHS and remains the cornerstone of healthcare provision in the UK. Unlike salaried doctors, GP partners own a share of their practice and draw income from business profits.

Historically, this format has been a draw for ambitious medical professionals because it combines the roles of doctor and self-made entrepreneur. Successful practices can grow quickly and nurture a legion of happy customers.

But today the model is seen as less attractive, so much so that the government has launched a review into GP partnerships to discover reasons why doctors are opting out. Official data shows that the number of GP partners working in England has fallen by nearly 5,000 over the last 10 years.

According to Emma Bower, editor of GPonline, a website providing news and opinion for the medical profession, stemming the tide will be no easy task, but a solution will be high on the government’s agenda.

“Studies show that partnerships are the most cost-effective way to deliver patient care. GPs have a stake in their business and obviously want it to be profitable, so they are potentially more willing to innovate to drive up efficiency and improve conditions for staff.

“One issue is that partnerships received a major funding boost in 2004, which didn’t play well in the media, and so ever since then the government has been more cautious. Also, there’s a shortage of GPs in general, which means locums can earn a lot more than they used to.

“By becoming a locum, a GP can earn a high wage without taking on all the liabilities of running a business, which is why the partnership model is comparatively less attractive. Partnerships are not limited liability, so the risk is personal and it can be quite high.”

Newer factors have increased the challenge at hand. Data rules under the EU-wide General Data Protection Regulation (GDPR), which came into force in May, have complicated workloads without compensation. A survey of GPs and practice managers by GPonline revealed they are dealing with an increase in subject access requests (SARs) from patients.

GDPR prevents practices from charging for the requests and 57% of respondents said they had seen more as a result. Some practices were spending at least seven hours a week of staff time responding to SARs, time that must be paid for without new money coming in.

Separate research of 112 partners and managers published in December revealed that almost a third had seen income from fees fall in the last 12 months, with only 14% claiming it had increased. Some 45% said income had flatlined.

The British Medical Association (BMA), the professional body representing UK doctors, says the model must be safeguarded, acknowledging that many practitioners are under strain.

Dr Richard Vautrey, BMA GP committee chair, welcomed the government’s review saying partnerships were, “good for doctors, our staff, patients, communities and the wider NHS”, but added “partnerships are struggling to recruit new GPs [because of] rising workload pressures, premises liabilities and indemnity risks”.

The BMA has illustrated the challenges faced by some doctors with the example of a GP who bought into a partnership using a £150,000 business loan, but soon after fell ill and was off work for seven months. He was handed a bill for £65,000 to cover his appointments and £45,000 for tax payments.

This is an extreme example, but illustrates the concerns felt by GPs when they weigh up career options. Difficulties recruiting GPs, the daily challenge of running a business and the risk profile makes a job as a salaried GP seem more attractive.

“GPs in the system need reassurance,” says GPonline’s Emma Bower. “The review is looking at how to make the model more attractive and doctors need to feel confident that buying into a practice won’t end in disaster.

“It needs more GPs coming through and somehow partnerships must become more financially rewarding to account for the extra risk of owning the business. There is more money coming via the government’s long-term plan for the health service, so we’ll wait and see how much of it ends up in primary care.”

One option for the government would be to follow Scotland’s lead and deliver a guaranteed income for GP partners, together with preferential premises loans designed to soften the financial burden of owning the practice property.

Other solutions are arriving via the free market. When he heard that Marston Medical Centre would be closed, Stuart Gale, owner of Oxford Online Pharmacy, absorbed the practice into his business, thereby safeguarding services for the local community.

He formed a partnership with the GP practice, run by Hedena Health, and redesigned his pharmacy to incorporate three GP consultation rooms and a waiting area. The new arrangement provides healthcare for up 100 patients a day and has the backing of the council.

“I see the ‘health hub’ model as the future of primary care on the high street, bringing multiple health services together under one roof,” says Gale. “Patients can be triaged at the counter by members of the pharmacy team and directed to either the GP waiting area or one of the pharmacy services.”

Done right, the GP partnership structure is value for money and provides an excellent career path for GPs who want to move beyond salaried employment. But its declining popularity in recent years shows that amendments are needed to return the model to its former glory.