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GP Partnerships – how to balance risk and reward

26 July 2021

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Medical accountant Graham Leyfield reviews the changing appetite for partnerships and highlights key considerations to reflect on before choosing a role in partnership

There is no doubt that fewer GPs are interested in taking up roles in partnership than in the past. As of December last year, the number of full-time equivalent GP partners was 17,173 – down around 900 from the year before.

In an effort to increase the take-up of partnerships, NHS England introduced a ‘golden hello’ scheme in its February 2020 update to the GP contract.

The ‘New to Partnership Payment Scheme’ offers a one-off £20,000 payment1 to qualifying clinicians looking to enter a full-time partnership role in general practice in England and provides a 20% contribution towards tax and National Insurance, as well as money towards overheads and training and skills development costs.

However, a survey of GPs conducted earlier this year by Wesleyan Bank2 suggested the initiative is not serving as the incentive that it was hoped for.  Almost nine in 10 (87%) respondents, which included salaried GPs, locums and partners, said that they do not consider the scheme a reason to seek a partnership role. 

Partnerships – still in favour?

The survey found increased pressure and stress, a lack of work-life balance and a lack of NHS or government support were respondents’ biggest worries about taking on a partnership.

In the past, GPs usually followed a relatively structured career path culminating in a partnership position, but those entering general practice now are increasingly choosing to embark on ‘portfolio’ careers – taking salaried or locum positions that align with their own lifestyles or goals.

For many GPs, working as a locum gives flexibility – clinicians can choose which jobs they would like to work on and can decide where and when they want to work. For those considering retirement, it can also be a way to start winding down their career.

Despite this, however, the job security of partnership remains a strong lure.

What next for partnership?

There are benefits for those that pursue this career route, including the potential to increase earnings and to have a direct say in the day-to-day running of the practice.

While the financial incentive of the ‘golden handshake’ hasn’t necessarily served as a motivator for GPs in salaried, locum or existing partnership roles, it may prove to be an attractive incentive for those in other clinical positions.

The scheme is currently open to 12 staff groups, including nurses, pharmacists, physiotherapists and dietitians, and NHS England has said it hopes to open the scheme to practice managers in the future.

Is partnership for me?

For anyone looking to take the step up to partnership, it is essential to carry out thorough due diligence into the practice they are thinking about joining. This will include taking a close look at the accounts of the practice, any potential issues relating to staffing, and the partnership agreement itself.

Partners will need to be aware of ‘retirement clauses’ – rules outlining when partners in the practice can choose to retire – and make sure they understand any rules regarding sickness and what the partners’ obligations are to their colleagues in these cases, as well as vice versa.

Individuals will need to be mindful that once they become a partner, they are no longer employees and some of the protections and benefits they might have once expected will no longer be automatically granted. For example, they won’t have statutory maternity rights; a potential new partner who is planning a family will need to be mindful of the potential cost that they might have to meet to take an extended period of time off.

Is property included?

New partners will need to consider what exactly they’re becoming a partner in – the practice itself, or the practice and the premises – and if it’s the latter, they will also need to understand the mechanics of that property ownership.

It is not unheard of for the premises to be owned by retired former partners who effectively become the landlords of new partners who join. It is vital to know the details of – and to document – which partners are responsible for what, and to understand factors such as what happens to existing partners’ shares in the premises once they retire.

In some cases, practices might have arrangements where retiring partners are obliged to sell their equity in the property to continuing partners. Here, it will be important for partners to think carefully about their plans for succession, to ensure situations don’t arise where a small number of partners are left liable for buying increasingly large proportions of the property equity that they might not be able to afford.

Finally, they will also need to think carefully about their finance options when it comes to buying into the premises.

Buying into the premises isn’t overly risky as partners can receive notional rent income which covers the loan cost. The main aspect to focus on is whether they join any existing commercial loans, where they could be jointly or severely liable for it all, or if they need to finance their share individually through a partner equity loan.

Cover all bases

Ultimately, GPs, clinicians and practice managers, whether considering partnership or an alternative career route, need to think about all their options, what they mean for them and how they align with their long-term ambitions.

Understanding these points will be key to anybody making the right decision for their specific circumstances.

Graham Leyfield is account manager at the Wesleyan Group, a specialist financial services mutual for GPs

Footnotes

1. This is pro-rata for a full-time equivalent role (37.5 hours per week). Participants to the scheme must commit to working at least two clinicals sessions – each of a minimum of 4 hours and 10 minutes – per week for the duration of their five-year term.

2. Wesleyan Group based this research on a survey of 201 medical professionals in Wesleyan’s customer base, comprising salaried GPs, locums and partners.

Read more Pulse Intelligence articles here.


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