Intended for healthcare professionals

Rapid response to:


New GP contract deal: a game changer for primary care?

BMJ 2019; 364 doi: (Published 01 February 2019) Cite this as: BMJ 2019;364:l531

Rapid Response:

Re: New GP contract deal: a game changer for primary care?

Dear Sir/Madam,

The recent publication of the partnership review highlights some of the issues with the current partnership model. Whilst some interesting recommendations are suggested, the report also serves as a reminder of what is fundamentally wrong with GP partnership in the 21st century.

In an attempt to stave off private providers and hospital trusts, there has been a move to work in collaboration with other practices in localities and federations. Some have been more successful than others. However, most if not all of these, are underpinned by an unwavering desire to maintain individual practice identity, and thus preserve the autonomy of partners. For me, this is a barrier to true integration. The demographics and mobility of the population is changing across the country, with a change in patient need and expectations. Holding onto a "cottage industry" approach to general practice is a barrier to progress.

I would argue that those holding onto this false panacea are either blinkered by nostalgia and possibly also the financial control that being a small business contract holder offers. For example, a partnership can make more money by hiring fewer doctors. This then puts pressure on other services e.g. Accident and Emergency & Urgent Care Centres, as patients cannot get an appointment to see the GP. Perhaps we could overlook this in the past, but not now. The needs of individual partners or partnerships cannot be put ahead of that of patients and the NHS as a viable entity.

The partnership review reads like a final rallying call from a general to their troops knowing the inevitability of defeat. However, I would argue that doing away with the current partnership model is not defeat, rather progress and evolution that is needed to save general practice and arguably the NHS, of which we are the bedrock.

Yours faithfully

Dr.Milan Dagli, MPharm, MB ChB, MRCGP, PGCert

Pinner, Middlesex

Competing interests: No competing interests

13 February 2019
Milan Dagli
General Practitioner
Pinner, Middlesex