BMJ Careers: Guide To GP Partnerships

What is a GP partner?

A GP partner is a self-employed general practitioner who, alongside other GPs, and sometimes also nurses or other healthcare staff, is responsible for running their own practice. Besides providing services and managing patients, GP partners also manage the practice staff, the finances and the administrative work associated with running the practice. 

Unlike salaried GPs or GP locums, GP partners are not only healthcare professionals but also business owners. They therefore have more responsibilities, but also a lot more control over their work.

 

Advantages of becoming a GP partner

As a GP partner, you are both a primary care physician and a business owner. Although this means extra responsibilities and commitment, it also comes with benefits.

• Control: GP partners have a lot of control over their practice, how it is run, who it employs, what services it offers, and how it performs financially. Although this also entails a lot of managerial and administrative work, it means that you and your partners can shape the identity of your practice freely.

• Financial benefits: GP partners generally earn more than their salaried or locum colleagues, owing to the extra responsibilities they undertake. A full-time GP partner in the UK earns an average of £109,000 per annum, although this varies between regions and UK nations. 

• The ‘New to GP partnership’ scheme: Starting in 2020, there is a new scheme in place which offers an incentive payment of up to £20,000 to new GP partners, who in return agree to work the minimum number of clinical sessions (two) per week for the next five years. A £3,000 training grant is also offered alongside this to help new GPs fund the training needed to develop their early partnership skills.

• Stability for the doctors and the patients: Most partners remain in their partnerships for a long time, some even stay in one partnership their entire career. This enables the partners to create an identity for the practice, hire and train a good, organised and synchronised team, and forge good relationships with their patients, who will also appreciate the continuity of care.

• Opportunity to make a change in the specialty: Because partners are independent general practitioners and take full responsibility for running their practice, they can truly advocate for their patients, and they can easily implement changes to their practice. They can also share their best practice with other GP surgeries and thus improve the quality of patient care more widely.

 

Disadvantages of becoming a GP partner

Although becoming a partner comes with many great benefits, it is also important to be aware of the downsides of the role in order to make a fully informed decision. 

• Level of commitment and liability: Joining a partnership is a large time and financial commitment. Buying into a partnership is often costly, especially if the existing partners own the building where the practice is situated as then you will need to own a part of the building to become a full partner. Additionally, as business owners, partners are liable for any losses, such as paying redundancy pay should there be the need to make some members of staff redundant or covering the remaining mortgages and other payments should one of the partners retire or resign. This can make leaving a partnership very difficult.

• Parity: Full parity in a partnership means that all partners earn equal salaries. In some partnerships you may have to wait two or three before gaining full parity. The waiting time is mostly because new partners may not be able to contribute fully to all aspects of the practice right away. This is however becoming increasingly rare, with many partnerships offering full parity either immediately upon joining or after 12 months. 

• Self-employment: As a partner, you are not an employee and thus do not have automatic sick pay, holiday pay, or paid parental leave. Partners are self-employed, and it differs from one partnership to another whether they will offer these benefits or not, and in what amounts. This should all be stated in the partnership agreement which is specific for each partnership and must be agreed to by all partners.

• Less clinical work: GP partners often complete less clinical work than their salaried colleagues, mostly because administrative and managerial tasks associated with running a practice make up a proportion of a GP partner’s work.

 

How a GP practice is funded, and how much do GP partners earn

In England, NHS England has the formal responsibility for commissioning all primary care services. However, Clinical Commissioning Groups, or CCGs, are increasingly taking over the delegation of commissioning these services, and it is CCGs that are nowadays usually responsible for commissioning local GP practices in keeping with the national guidelines.

Every GP partnership must hold an NHS GP contract to run an NHS-commissioned practice. There are three main types of contracts: General Medical Services (GMS) contract, Personal Medical Services (PMS) contract, and Alternative Provider Medical Services (APMS) contract. GMS is a standard contract that is negotiated every year between NHS England and the BMA General Practice Committee. 

PMS on the other hand is negotiated locally between either the CCG or NHS England and a specific GP practice. Finally, APMS is negotiated between another organisation, such as a private company, and the CCG. PMS and APMS both offer greater flexibility in service provision than GMS.

In Scotland, following a recent vote for a new GP contract, the funding of GP practices is undergoing a reform. The goal is to standardise the income range for GPs and establish a set pay progression. 

The earnings of GP partners varies from partnership to partnership, and also varies from year to year. Earnings often depend on the profitability of the practice, which in turn depends on the local population and its needs, and on how well the partners develop their business. On average, a GP partner in England earns about £110,000, while in Scotland (and similarly in Wales and Northern Ireland) the average GP partner’s pay is £98,700.

 

Becoming a GP partner 

Because it is such a long-term commitment (and unless you want to establish your own partnership from scratch) you will need to carefully choose a partnership in which you will be happy working for the foreseeable future. When applying for vacancies in different partnerships, you will be invited to visit the practice and to come for an interview. 

When visiting and familiarising yourself with the practice, it is important to ask questions to find out more about how the partnership and the practice works. Consider if you like all the partners and whether there is mutual respect in the partnership, how organised the practice is and their typical workload, as well as the financial situation of the practice, ie, how much would it cost to buy-in, and what their usual monthly/yearly drawings are. 

Interviews can come in different formats, from a traditional discussion with the senior GPs, to an OSCE-type assessment with up to four stations. During an interview for a GP partnership, there are three main areas the interviewers will assess you on:

1. Clinical skills

2. Understanding of the primary care environment

3. Managerial and leadership abilities and experience

In a partnership setting, the managerial and leadership aspect of your skill set is a lot more important than in a salaried position, thus you should make sure you can talk about your managerial and leadership skills and support this with real-life examples and achievements.

Interviewers will also ask more detailed questions about the job and examine your understanding of the non-clinical responsibilities associated with being a GP partner. This includes matters like quality assurance and governance responsibilities, or liaison with PCT. It is therefore important to do your homework and research the job description carefully before the interview.

 

GP Partnership agreement

The GP partnership agreement is a document that is specific to each partnership, and it describes the following:

• The partners’ duties and responsibilities

• How decisions are made and how disputes between GP partners are resolved

• Outline of authority

• How the profits are shared

• How the capital income is distributed

• Holiday pay, sick pay, and paid parental leave entitlements for partners

• Resignation and retirement policy

• Grounds and policy for expulsion of a partner

 

Resigning from a GP partnership

The first step to resigning from a GP partnership is submitting a Notice of Resignation or Retirement addressed to the remaining partners. The partnership agreement should allow for a notice period of approximately 3 months, but this can vary between partnerships. 

The partner who is leaving the practice will need to inform the Primary Care Support England, or a Scottish/Welsh/Northern Irish equivalent so that their pension records can be updated. 

The remaining partners will need to record their updated partnership shares and review their banking arrangements to remove the partner who has resigned/retired from all practice accounts. 

The leaving partner may opt to retain ownership of the surgery property, or they can choose to give up ownership, in which case the ownership must be transferred to the remaining partners. If a salaried GP partner is leaving, they will need to be taken off the payroll.

 

Resources to find out more about GP partnerships

More information about GP partnerships can be found for example on the BMA website, the NHS England site, or even the UK government website. Additionally, to get to know the role more closely, there are other resources such as the “The need-to-know when considering GP partnership” and ”GP partnership considerations” podcast by Robert McCartney.

 

References

1. Pulse. What to look for in a GP partnership. Accessed from: https://www.pulsetoday.co.uk/views/practice-personal-finance/what-to-look-for-in-a-gp-partnership/ (accessed Aug 2021)

2. The RSM UK. Thinking about becoming a GP partner? Here is what to consider. Published Sept 30, 2020. Accessed from: https://www.rsmuk.com/ideas-and-insights/thinking-about-becoming-gp-partner (accessed Aug 2021)

3. GP Training Support. Becoming a GP partner- advantages and disadvantages. 

4. Isc Medical. GP Partnerships. Accessed from: http://gptraining.info/becoming-gp-partner-advantages-disadvantages (accessed Aug 2021)

5. The BMA. New to GP partnership scheme. Accessed from: https://www.bma.org.uk/advice-and-support/career-progression/gp-workforce-initiatives/new-to-gp-partnership-scheme  (accessed Aug 2021)

6. Kotecha, A. GP Online. Why being a GP partner is still a great career choice. Accessed from: https://www.gponline.com/why-gp-partner-great-career-choice/article/1584612  (accessed Aug 2021)

7. Watson N, Manek N. Myth busting questions on partnerships for GP trainees. Published Oct 2, 2018. Accessed from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/745318/myth-busting-questions-on-partnerships.pdf  (accessed Aug 2021)

8. Beech J, Baird B. The Kings Fund. GP funding and contracts explained. Published Jun 11, 2020. Accessed from: https://www.kingsfund.org.uk/publications/gp-funding-and-contracts-explained  (accessed Aug 2021)

9. Hindley S. Stewart Hindley. How are GP practices funded. Published Mar 18, 2020. Accessed from: https://www.stewarthindley.co.uk/how-are-gp-practices-funded/  (accessed Aug 2021)

10. Scottish Government (gov.scot). A review of GP earnings and expenses. Published Nov 2017. Accessed from: https://www.gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2017/11/2018-gms-contract-scotland/documents/00527540-pdf/00527540-pdf/govscot%3Adocument/00527540.pdf (accessed Aug 2021)

11. Campbell R. GP practice manager UK. Resignation, retirement, or death of a partner. Published Jun 2, 2021. Accessed from: http://gpsurgerymanager.co.uk/resignation-retirement-or-death-of-a-partner/ (accessed Aug 2021)