GP Partnership Research Articles

Exploring gender differences in uptake of GP partnership roles: a qualitative mixed-methods study.

The unadjusted gender pay gap in general practice is reported to be 33.5%. This reflects partly the differential rate at which women become partners, but evidence exploring gender differences in GPs' career progression is sparse. To explore factors affecting uptake of partnership roles, focusing particularly on gender differences. Convergent mixed-methods research design using data from UK GPs. Secondary analysis of qualitative interviews and social media analysis of UK GPs' Twitter commentaries, which informed the conduct of asynchronous online focus groups. Findings were combined using methodological triangulation. The sample comprised 40 GP interviews, 232 GPs tweeting about GP partnership roles, and seven focus groups with 50 GPs. Factors at individual, organisational, and national levels influence partnership uptake and career decisions of both men and women GPs. Desire for work-family balance (particularly childcare responsibilities) presented the greatest barrier, for both men and women, as well as workload, responsibility, financial investment, and risk. Greater challenges were, however, reported by women, particularly regarding balancing work-family lives, as well as prohibitive working conditions (including maternity and sickness pay) and discriminatory practices perceived to favour men and full-time GPs. There are some long-standing gendered barriers that continue to affect the career decisions of women GPs. The relative attractiveness of salaried, locum, or private roles in general practice appears to discourage both men and women from partnerships presently. Promoting positive workplace cultures through strong role models, improved flexibility in roles, and skills training could potentially encourage greater uptake.

Establishing a Resource to Assess Musculoskeletal Health in Older Adults in the Post-COVID-19 Era: Time to SaLSA?

Sarcopenia and osteoporosis are associated with morbidity and mortality. The development and progression of these two interrelated conditions are related to genetic and lifestyle factors, including nutrition and physical activity. Restrictions placed on individuals due to the COVID-19 pandemic and infection have led to widespread lifestyle modifications, with data suggesting a negative impact on physical activity levels. There is an urgent need to understand the effect of the pandemic on musculoskeletal health in older adults, at a time when COVID-19 infection and restrictions remain a barrier to research studies. We tested the feasibility of recruiting local community-dwelling older people to establish a new cohort investigating musculoskeletal health—the Southampton Longitudinal Study of Ageing (SaLSA). We invited 1993 community-dwelling older adults registered at the Living Well GP partnership in Southampton, UK, to participate in a study. Questionnaires were completed by participants on health, lifestyle, medication use, comorbidities, physical activity, nutrition, sarcopenia, osteoporosis, and quality of life. Permission was sought for future contact. Descriptive statistics were used on the initial pilot of 175 returned questionnaire data. The median age of participants was 80.4 years in both sexes, 81.3 years (77.9–84) in females, and 81.1 years in males (77.3–83.6). The majority (N = 168/171, 98%) of participants were of white Caucasian background; 36/53 (68%) female participants and 38/119 (32%) male participants lived alone. Over 80% (295/353) consented to be contacted for future studies. Recruitment of participants from a primary care practice into a research study was feasible. The next steps are to perform detailed musculoskeletal phenotyping through physical performance measures, grip strength dynamometry, DXA scanning, high-resolution peripheral quantitative computed tomography (HRpQCT), thigh ultrasound, and muscle biopsy, in a subset of participants. Our vision for SaLSA is to build a platform for discovery science and mechanistic studies, with the goal of improving the health care of older people.

GPs and green socks: don't get stuck between a sock and a hard place.

Simply wearing a particular colour of socks could lead to a GP partner losing their job. This is a legitimate and legal approach within some GP partnership agreements, as a way of removing a GP partner. An increasing number of GP partnership contracts contain this legal caveat known as ‘the Green Sock Clause’.1–3 It was developed from similar clauses used in legal partnerships whereby a partner can be expelled without reference to their work but is instead described as due to their wearing of green socks 2,4–5. This can be helpful when the relationship between partners has irretrievably broken down4 and can make dissolving partnerships easier and less protracted.6 There has been no research into how aware GPs are of this clause, nor of their sock-wearing habits. However, we have attempted to address this slightly by undertaking a recent observational study last year. An online questionnaire was …

Viewpoint: Support for grassroots could rescue general practice.

What has happened to the career that I entered 26 years ago? I am sure this is a common thought among my generation of GPs. However, general practice is a hugely complex process and it is difficult to pick out specific areas that need to be changed to mount a rescue effort. Changes have been successively imposed on a primary care system consisting of GP partnerships that was formulated for a different era, and so it is little wonder that it is no longer fit for purpose. The unsustainability of the current system has become more apparent over the last decade since the New Contract. The principle paradigm is one of data collection. Numerous other …

Future of GP partnership model is uncertain, as “forces” against it mount, says RCGP president

The future of the GP partnership is in doubt, as the disadvantages of the system begin to outweigh the positives, the president of the Royal College of General Practitioners has said. Speaking at the college’s annual conference in Glasgow on 1 October, Mike Pringle said that future GPs may require a more flexible career path than that provided by the partnership model. Responding to a question on the future of general practice from a junior doctor in the third year of specialty training, Pringle said, “Firstly, the idea of partnership for life is almost certainly not going to work.” He added, “For your generation and the generations coming up …

Evaluation of a partnership between primary and secondary care providing an accessible Level 1 sexual health service in the community

Summary Comprehensive testing for asymptomatic sexually transmitted infections in Northern Ireland has traditionally been provided by genitourinary medicine clinics. As patient demand for services has increased while budgets have remained limited, there has been increasing difficulty in accommodating this demand. In May 2013, the newly commissioned specialist Sexual Health service in the South Eastern Trust sought to pilot a new model of care working alongside a GP partnership of 12 practices. A training programme to enable GPs and practice nurses to deliver Level 1 sexual health care to heterosexual patients aged >16 years, in accordance with the standards of BASHH, was developed. A comprehensive care pathway and dedicated community health advisor supported this new model with close liaison between primary and secondary care. Testing for Chlamydia, gonorrhoea, HIV and syphilis was offered. The aims of the pilot were achieved, namely to provide accessible, cost-effective sexual health care within a framework of robust clinical governance. Furthermore, it uncovered a high positivity rate for Chlamydia, especially in young men attending their general practice, and demonstrated a high level of patient satisfaction. Moreover the capacity of secondary care to deliver Levels 2 and 3 services was increased.

Trainees’ experiences of a four-year programme for specialty training in general practice

In 2012 the first Scottish cohort of trainees completed a four-year training programme in general practice. In the same year, the Royal College of General Practitioners (RCGP) successfully made the educational case for lengthening training from three to four years in the rest of the UK. This project sought to evaluate the experiences of the initial four-year cohorts (2012 and 2013) to gain the Certificate of Completion of Training (CCT). We aimed to capture trainees' experiences of the training programme and how well it prepared them for independent general practice. We also investigated whether perceived levels of clinical confidence in key areas of the curriculum improved over time. To achieve this we undertook a cross-sectional online questionnaire survey. Open-ended questions were included to elicit more in-depth responses by participants on all issues. A total of 20/49 trainees in 2012 (40%) and 46/50 trainees in 2013 (92%) completed the survey. Perceived mean levels of clinical confidence in the key curriculum domains surveyed in 2012/13 were generally high, particularly in clinical domains or topics such as cancer management (94%) and paediatrics (94%). It was lowest in non-clinical domains such as GP partnership (57%), practice management (68%) and leadership (65%), but also in some skills specific to general practice that are of importance where healthcare delivery is increasingly community-based such as public health (63%) and caring for the long-term unemployed (33%). This small study will inform the implementation of an integrated, community-based model of training to enable GP trainees to achieve the clinical and generalist skills required in the immediate future.

Will 2014 be the year a new consultant contract starts as the GP partnership model crumbles?

After another year of overhaul for doctors’ careers, Abi Rimmer asks leaders of the profession what changes to jobs and training they expect to see in 2014

The limits of market-based reforms in the NHS: the case of alternative providers in primary care

BackgroundHistorically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs).MethodsTwo qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation.Results and conclusionsWe found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services.The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between transparent processes, fair procurement, performance assurance and cost.

How to prevent GP partnerships breaking down

Breakdowns in relationships within a general practice partnership are rarely discussed, but can be stressful and expensive. <b>Ruth Taylor</b> looks at how problems can be addressed and where to turn for support

Only one in 10 new GPs get a partnership on qualification

Only 10% of new GPs in the BMA’s cohort study of medical graduates secured a GP partnership post on receipt of their certificate of completion of training (CCT) last summer. Nine of the 91 newly qualified GPs followed by the BMA throughout their training since graduation from medical school in 2006 were in a partnership post as of August 2011, when they had completed GP training. The GPs in the cohort were most likely to be working as a salaried GP (34%) or a locum (22%) once they were awarded their CCT in August …

The GP partnerships debate

New partnership opportunities in general practice have become rarer recently, which has left many newly qualified general practitioners unhappy. <b>Helen Jaques</b> hears the arguments for and against making more partnership roles available to young GPs

Market reforms in English primary medical care: medicine, habitus and the public sphere

Drawing on interviews with English primary care doctors (GPs), this paper examines GP responses to reforms intended to introduce a market in primary health care. GPs' reactions are conceptualised in terms of a GP habitus, which takes for granted the superiority of 'public' providers (i.e. GP partnerships) in the provision of care. GPs are actively involved in the defence of the public sphere, which is neither a neo-liberal minimalist market state, nor a wholly altruistic state, responding to consumers' wants. The public sphere they defend is one in which boundaries are drawn about entitlements and GPs are actively engaged in defining and policing these boundaries. The GP habitus can be seen as shaping responses in ways which serve GP interests. In the context of struggles involving various social actors (e.g. private providers, third-party payers, patients) with different stakes in the field of general medical practice; this public service orientation may enable GPs to reap cultural capital. At the same time, the habitus constrains action in a way which limits resistance to reforms threatening GPs' interests, with GPs responding by coping, rather than downing tools or engaging in active confrontation.

GP principals leaving practice in the UK

Objectives: To explore gender and career-stage differences in factors affecting GP retention, and to draw out lessons for enhancing the stock of GPs across the UK and Europe.Methods: A postal survey of all 1083 GP principals practising in England and Wales in October 1996 but not 1997.Results: After removing those who had died, emigrated or who could not be traced, the response rate was 63%, with 621 completed questionnaires being returned. Our most striking finding was not the difference, but the similarity in doctors' attitudes. Regardless of gender or career-stage, the most important reasons for leaving a GP principal post were high administrative and clinical workload and high patient expectations. Amongst younger leavers, both men and women also rated lack of flexible hours and GP partnership problems as important. Moreover, whilst women were more likely to say that better opportunities to accommodate family would help them return, a minority of men regarded those factors as relevant too. Another key finding was the general desire for career variety that could not be accommodated as a GP principal. Among older leavers, both genders were likely to have moved to a non-principal post they could combine with other NHS or private medicine. Even amongst young men, the group least likely to combine roles, 13% had a second job. Finally, there was similarity in the importance both genders placed on 11 career structure and job-related factors felt to be discouraging new GP recruits.Conclusions: Whereas “traditional” UK general practice met the full-time, job-for-life needs of earlier male-dominated cohorts of GPs, it no longer seems entirely appropriate either for the increasing number of women GPs or many of their male counterparts. Maximising the stock of GPs across the UK and Europe requires the option of greater flexibility to accommodate doctors' desire for varied lifestyle and employment options at all career stages.

General practitioners' views of clinical guidelines for the management of asthma.

To assess the views of GPs on the value of clinical guidelines for the management of asthma. Structured questionnaire survey. Bromley Health District. All (160) GPs in health district. Evaluation of each item of clinical guidelines as to whether 'obvious', 'useful' or 'controversial'. Ninety-four (59%) of GPs responded. There was considerable variation in views on all 26 guideline items in the questionnaire. The average GP thought that 11.5 items were obvious, 8.5 useful and 5.7 controversial, but these views showed no relationship to the GP's age, sex, ethnicity or partnership size. Clinical guidelines are usually written to be of value to a wide number of clinicians, but it appears that GPs at least have more individual needs on issues of clinical management. This may explain the reported limited impact of guidelines on clinical practice.

GP partnerships ‘not far off’

GP partnerships ‘not far off’

GP partnership status for nurse practitioners?

GP partnership status for nurse practitioners?

Call for community nurses to create non-hierarchical GP partnerships

Call for community nurses to create non-hierarchical GP partnerships

Points: Deferring parity in GP partnerships

Points: Deferring parity in GP partnerships

Points: Deferring parity in GP partnerships

Points: Deferring parity in GP partnerships