Historic GP ‘partner model’ should be phased out in England

A new IPPR report has called for general practitioners to become salaried employees of the NHS, rather than independent partners who run their own GP practices.

The think tank’s researchers argue that such a shift, which would overturn the historic model of general practice that has been in place since 1948, would enable the NHS in England to deliver better access to and quality of primary care in the community. To be phased in, the move would also help to address the workforce crisis in general practice.

IPPR also suggests that the phasing out of the partner model is likely to be crucial to delivering some of the government’s manifesto priorities, including delivering 50 million more GP appointments a year in England and raising GP numbers by the equivalent of 6,000 full-time doctors. The number of practising GPs per 100,000 people is now at its lowest since 2003.

The report, Realising the Neighbourhood NHS: Delivering a new deal for primary care, examines what might have happened had the trend in GP recruitment in England between 1970 and 2010 continued. In order to return to that trend, the government would need to recruit some 7,000 fully qualified GPs by 2025 – 4,000 more than the manifesto pledge.

Currently, 36 per cent of respondents tonew IPPR/Savanta-ComRes polling said they waited more than a week for their most recent GP appointment, while three per cent of people – equivalent to 1.7 million across the country – said they were unable to access any suitable appointment last time they tried to book one.

The suggestion is that the NHS in England should phase out the current model and introduce new NHS ‘Neighbourhood Care Providers’ (NCPs) with GPs working directly for the NHS, not as independent contractors. These new NCPs, which would serve communities of between 50,000-100,000 people, would join up primary, community and mental health care and give patients access to longer opening hours, diagnostics and treatment in the community.

The report authors argue that these changes would also help address workforce pressures by allowing ‘doctors to be doctors’ and focus on patient care rather than managing ‘businesses and buildings’.

The IPPR also calls for a radical transformation of the primary care estate, which is too often unfit for purpose because of chronic underinvestment by GP partners unable to access the financing they need. IPPR argues that the government should commit £500 million annually for a decade in England, through borrowing, to build 1,300 new primary care hubs and invest in new technology to enable digital access to primary care.

Harry Quilter-Pinner, IPPR Senior Research Fellow and report co-author, said: “We are facing a crisis in general practice. Patients can’t get access to the care they need. Staff are overwhelmed by workload pressures and stress. Since 1948 GPs have been small, local, private contractors. But this model is no longer working. We need to join up primary, community and mental health care in new ‘Neighbourhood Hubs’ and give patients access to the best care when they need it most. This requires us to finally welcome GPs fully into the NHS family through a new right to direct NHS employment.”

Martin Marshall, chair of the Royal College of GPs, said: "The College is hugely supportive of the partnership model of general practice, within a mixed and flexible economy of contractual models. It allows GPs to innovate in the best interests of local populations and it provides excellent value for money for the NHS.”