Adnan Saad is a GP Principal at Sheepcot Medical Centre, Watford; Associate Professor of Family Medicine at St. George’s University, Grenada; and Clinical Tutor at Imperial College School of Medicine, London.
GP partnerships have gradually been on a steady decline over the last decade.1 With a generation of senior and capable partners retiring and not being replaced at the same rate, there is a huge concern of seeing this post continue to diminish. Hence there is not only a need to find a skilled partner who would help stratergise and drive the practice forward, but also to hold onto them and stop them from leaving.
A practice partnership has often been compared to a marriage,2 with autonomy and self-determination; designated roles where each partner takes a lead and shows accountability; generate income; have the freedom to innovate; ability to express opinions without fear of criticism; have an equal say/vote; and have the respect, loyalty, honesty (transparency), and support of their fellow partners.
“A practice partnership has often been compared to a marriage … “
Finding the right partner is critical. Many practices may wish to advertise for this vacancy. Although the advantage in this is having a wider capture audience, there is still an element of risk as neither the incoming partner nor the practice know each other and are heavily reliant on the references provided and the partnership interview.
Alternatively, the partnership may wish to recruit from GPs it has had previous dealings with such as previous GP trainees, locums, its present salaried GPs, or colleagues known to the practice. The obvious advantage here would be that both the practice and the potential candidate have worked together and are aware of each other’s strengths and shortcomings. Hence a shrewd partnership would always be aware of succession planning and of those known doctors it may wish to head-hunt.3
Once the new partner has joined, it is advisable for practices to have a period of mutual assessment to determine if the practice and incoming partner are happy to continue working together. This could be 6–12 months in duration, on which a new partnership agreement is drawn up by a lawyer who specialises in GP contracts and signed by the new incoming partner and all existing partners. This contract should have a sense of fairness to all parties and ultimately look to protect the partnership.
Having a financially strong partnership instantly makes a practice more appealing to join. It gives the message that the partnership is entrepreneurial, innovative, well run, and well organised. It is not unreasonable for a potential partner to request to see the last 3 years’ worth of practice accounts, as this not only demonstrates they clearly want to know what they are getting into, but also shows the practice is acting transparently and in good faith. A financially successful practice would normally have a business manager, a partner who is the finance lead, and a practice manager, who in turn should maximise in every opportunity in strategically steering the practice forward, ensuring all works are being completed and claimed for in a regular and timely fashion.
“A partner who has resigned or retired offers limited or no further value to the practice.”
A partner who has resigned or retired offers limited or no further value to the practice. It is therefore in the interest of the partnership to buy back their share (at market rate), and to allow the incoming partner an opportunity to buy into the practice. This will make the potential partnership post more attractive and give the incoming partner a sense of ownership – a solid reason to stay. Many retired partners hold onto their share of the practice, but that is not in the interest of the partnership.
The working environment is crucial. An incoming partner may feel very uneasy if joining a practice with an unequal distribution of work, some partners constantly working from home and not doing their share of work, they not feeling heard or valued, facing conflicts of interest (such as the practice manager favouring one partner over others), or not being respected and treated as an equal. Furthermore, the longer established partners may expect the newly appointed partner to work excessively (just as they did). However, work–life balance is a key element in job satisfaction, and so should be strongly encouraged.4
It is therefore the responsibility of all partners and the practice manager to keep the partnership fairly and reasonably in check, and so strengthening the wellbeing and longevity of the partnership.
1. Bower E. More than 3,600 GP partners lost in four years as decline accelerates. GPOnline 2020; https://www.gponline.com/3600-gp-partners-lost-four-years-decline-accelerates/article/1684601 (accessed 24 Jan 2023).
2. Practice Business. Is it true that joining a GP partnership is like a marriage? 2020. https://practicebusiness.co.uk/is-it-true-that-joining-a-gp-partnership-is-like-a-marriage (accessed 24 Jan 2023).
3. Rough S. Partnership or salaried GP: what about the engaged GP? BMJ 2022; 376: o642.
4. Bodendieck E, Jung FU, Conrad I, et al. The work-life balance of general practitioners as a predictor of burnout and motivation to stay in the profession. BMC Prim Care 2022; 23(1): 218.