Legally, a partnership is an agreement between two or more individuals. It means one is always in control but within the framework of PCT /CCGs and other regulations; everything depends on the profitability of the GP practice and the relationship with the other partners, as set out in the Partnership Agreement – Deed of Partnership – where the relationship with other partners, including share of profits and losses, are usually set out and is witnessed by a solicitor. Partnerships are particularly common in professional services e.g. accountants, solicitors, vets, GPs, Dentists.
- Part own the business and have a say on how it is run;
- Share the profits and losses of the practice with the other partners.
- Stability of employment. Taxed on profits, not on income
- Use salaried staff to build the profits that will fund your lifestyle
- Personally liable for any losses. In fact any partner in isolation can be made responsible for the debts of the entire business.
- Taxed on profits and not on your income. If profits not drawn then have to pay tax on any undrawn profits.
- Management, accounting and other non-clinical considerations take up a lot of time.
- Unless one joins a GP Partnership in its infancy, joining a partnership later can be a costly business.
- Responsible for hiring, firing and monitoring staff. Being personally legally and financially responsible for the actions of others can be a daunting prospect.
- No employment rights. No sick pay, no holiday pay, no paid maternity. Being ill, pregnant or going on holiday simply means that less work gets down and therefore less income is taken. This in turns reduces profits and therefore your share.
It depends on a lot of factors and each has to be weighed carefully.
- Building costs – rent or lease, loans, interest rates, valuation etc. need careful assessment
- Share of contribution to the surgery working capital – bank accounts, purchase of stock, fittings and furniture etc.
- Time taken to achieve parity – 100% – if 4 years then, full costs paid after 4 years and also share of full profits after 4 years only. A partnership may only offer one 80%of normally expected full share in year 1, 85% in year 2 and 90% in year 3 and 100 % thereafter.
- Some may consider the new partner a full partner from day one.
- Depends on the make up of the local population and its needs and how the business is developed.
- As per one survey on average, a GP partner takes home approximately £110,000. The lowest figure is in the South West (approx.£100,000) and the highest is in the East of England (£120,000).
- Also, partners in practices where there are 6 partners or more earn approximately £20,000 less than partners in small practices.
An ordinary partnership can have between two and twenty partners. However, the Partnership Act of 2002 has made it legal for some forms of partnership e.g. big accountancy firms to have more partners who also enjoy limited liability.
People in business partnerships can share skills and the workload, and it may be easier to raise the capital needed. For example, a group of doctors are able to pool knowledge about different diseases, and two or three doctors working together may be able to operate a 24/7 service. When one of the doctors is ill or goes on holiday, the business can still cope.
There are forms available for Free for setting up Partnership Agreement and it is advised one such form is chosen as a draft for filling in the relevant details and then hand over to the Solicitor to formalise the Agreement between Partners in the GP Practice.
Candidate Briefing Pack for the post of GP Partner – Monkfield Medical Practice – 2011-12 – a wonderful example of laying out the details for an incoming Partner.
16.3 Management Miscellaneous
These refer to all types of GP surgeries – Single-handed practices, partners with 2 or more GPs, GMS, PMS, PCTMS, APMS or any other that may come in future changes.
For a surgery to move into modern times and to provide holistic care, the GP partners have to be very open to changes and not dwell on how things were done.
They must know the difference between high aspirations and its good, but far from perfect, results.
- Be alert and aware of instances, which are clearly;
- Avoidable as they inflict patient harm. Consider these are system failures not just accidents or bad luck;
- Learning from the achievements of other surgeries from various meetings attended.
- Define and focus on strategic challenges clearly;
- Look beyond improving individual issues e.g. registration or prescription and focus on improving the entire surgery;
- GPs are known for handling complex medical cases; they should aim to give its highest quality of care to all patients while reducing costs.
- The practices should be prepared for strategic transformation while preserving the successful ones. Fundamental changes are needed to surgery’s approach toward customers, workforce, operations, and information and knowledge management.
- Make improvement and transformation to the surgery a priority. The approach of patient-centered care is more important than a win for financial outcomes.
- Quality should be the vision and mission of the surgery not simply continuous improvement; make the staff provide excellence in all they do.
- GP partners should request all sections to report good performance data along with reporting an imperfect situation. Even if events had no patient impact, there was still significant room for improvement. “Are we as good as we can be?” should be the buzzword.
- Change, especially transformational change, is daunting for any organization. Practices face all daunting challenges inherent with endemic changes in NHS —cultural sensitivities, technological upgrades, and a vast organization to shift to “new thinking.” Self-examination and critical assessment should identify what caused barriers between desired outcomes and what actually happened on a day-to-day basis. There should be a bottom-up approach, the idea that real quality care must characterize the frontline relationship between receptionists and patient. Only then would the practices achieve consistent, good results.
- Every staff should be encouraged to report anything that does not seem quite right, without fear of reprisal. This culture emphasizes respect for the talents, knowledge, and experience of each team member. Transitioning to a workplace environment of greater equality can be tricky in a medical culture where physicians, by education and tradition, are considered the ultimate authority.
- Standardizing Hand Hygiene – compliance should reach 100%
- It is generally believed that clinicians, doctors, nurses, and therapists were lax in hand sanitation. The standard practice of preceding every patient contact with hand washing or germicide is not widely complied with. Through employee awareness, patient education, installation of additional sanitizer dispensers, reminder signs, the presence of monitors, and other means, compliance should increase to nearly 100%. After this increase, initial monitoring should be eventually reduced to sampling, and the change should be well ingrained in all staff.
Measurement and Reporting
Transformation is only possible with transparent reporting to all staff. One of the first steps is to make data accessible and forming a transparency group. This communicated a high level of trust in personnel and allowed for better decision-making.
Transparency means disseminating good and bad results in a clear, concise, and regular manner.
Change management succeeds when there is an innate understanding that people want to do good work. Access to the right data enables personnel to achieve and make informed decisions. Change management requires a culture transformation – not an easy change for any entity.
Initially, focus on core measures on patient satisfaction, infection prevention, control protocols, and mortality. Also collect data for some existing financial and operational measures.
Sustained transformation requires an on-going understanding that the collection of data for better patient outcomes is clearly mandated. If there are improved patient outcomes it becomes a business strategy.
Surgeries must concentrate on patient and quality outcomes, patient safety, and the patient experience. Surgeries must firmly believe that cost and the benefits of quality compete. Partners must make the cost of quality virtually a non-issue.
Each employee should perceive that they have two jobs: one in providing care or service, and the other in assisting in quality improvement. Surgeries must develop their own knowledge management system.
All information to help patient situations, to decision support tools, to contact information for subject-matter experts—should be stored in the computer system.
Surgeries should form a transparency group to measure and publish results across a spectrum of key benchmarks: safety, infection prevention and control, patient satisfaction, and complaints. Results should be published widely in print and through email to all staff.
‘Are we as good as we could be?’ – Should always be asked.
If one did nothing else except get people’s minds around the fact that no matter how good the practice is, ‘there are ways to be better’.
Surgery management has to shift their thinking and treat patients as customers. Good customer service is not an option; in today’s environment it is crucial to survive.