Considering Partnership
Introduction
Being a partner offers you opportunities, to shape your practice, improve patient care and your working practices. Although increasing the administrative workload, it often offers financial rewards, increased job satisfaction and job stability.
Considerations before becoming a partner
Locum first- get experience of different practices
Decide what sort of doctor you are and where you want to work.
Do you want well regulated, highly profit and target orientated culture or more relaxed attitude. Partnership and team – shared ethos
How many sessions- full time/part time whether it will be possible to change depending on your family commitments and other life changes.
What are your clinical areas of interest, skills and managerial areas, such as staff appraisal, audit, research, finance etc, you would like to develop long term.
Is there scope for some of these in your new practice. You will need to decide whether any of these are negotiable or not.
The accounts
These will show the profit trends and efficiency of the business. Beware of practices that are reluctant to show them. Get an accountant (who is familiar with GP accounts) to go over them. Medeconomics provides figures for GP pay and national fee comparisons per patient.
Find out the answers to these questions:
• Is the practice you are joining financially well managed?
• Who owns the building and Capital assets. Capital must be defined and is probably best recorded in a separate deed, particularly where not all capital assets, especially property, are held by all members of the partnership.
• How are profits divided? What is your profit share (gross pay) likely to be? How does the manager calculate how much partners can draw each month? Does the practice manager do cash flow forecasting?
• What are your drawings (net pay) likely to be?
• Find out what income is pooled? Does it include seniority awards, PGEA, and Clinical Assistant earnings?
• How does the practice deal with the partners’ income tax and income tax liabilities?
• Can you see the last three years practice accounts?
• Ask if anything has happened to materially affect the partnership profitability since the last set of accounts?
• When will you be expected to buy in and what are the likely costs of this? How will this affect your take home income how much will you have to put away for tax.
• When will you reach parity? (Often about three years)
• There may also need to be a provision about who receives any insurance proceeds and who pays for locums.
BMA Professional Services will check practice accounts for a fixed fee. Call them free on 0500 262829.
The Partnership
• How is work divided?
• Would they support you in your interests- such as teaching, minor surgery?
• What is their attitude to continuity of care.
• What is the structure of the GP’s day;
• When do the partners see each other? Do they have regular meetings amongst the GPs and also allied staff?
• Who leads the practice?
• Any non-principal staff?
• How up to date and organised is the IT. Do they have problem pages, regular medication reviews?
• Does the practice manager manage or just administer? Does he or she get a profit share?
• Number of appointments per day and average number of visits;
• Arrangements for extras and emergencies - is there a duty doctor rota?
• What is the access to secondary care like? Are there any GP beds nearby?
• What innovations have the practice made? Are there any local innovations in secondary care?
• How much leave? Maternity/ paternity leave.
• Sabbaticals
• It should be considered whether or not there should be restrictions on the right of each partner to take up other employment, etc which may detract from the business of the partnership.
• Who pays the locum fees if a partner goes long term sick.
• Is it a happy practice?
Partnership Agreement
Ask the local office of the BMA (or a solicitor experienced in GP partnerships) to review the document for you. BMA staff will do this for free for members. The GMSC have produced guidance on this, as has the BMA. It is worth getting a copy of these from your local office:
Partnership Agreements - Guidance for GPs - GMSC July 1996
Medical Partnerships under the NHS - BMA August 1995
Please note it is not part of the BMA service to provide commercial/management advice to practices or GPs. This guidance is for general use only and mainly concentrates on how partnerships should be considered in the light of any GMS/PMS/APMS contract/agreement together with the basic elements of partnership law. Practices/GPs are strongly urged to seek the specialist advice of accountants and independent lawyers in relation to the more detailed aspects of their partnership agreements.
The Downside…
Partnership breakup
Disputes within partnership are not uncommon. If not resolved amicably, it often results in protracted and expensive legal wranglings. This can also have contractual effects with the PCO. In the event of dissolution the practitioners may be in the position of having to reapply separately for individual GMS contracts with no guarantee of obtaining these. Furthermore, in the event of one partner leaving a practice, there may be a knock-on effect with respect to premises funding where property is leased by the partnership from a third party and the rent is funded by the PCO. This may well result in a cut in funding as not all of the premises are being used to deliver services under the contract.
Long term sickness can put pressure on the others to cover, particularly if there are gaps in locum cover and with the administration. If a partner ends up leaving this can again be an expensive episode in legal wrangling.
Unexpected tax bills from the unexpected practice earnings and expenses.
Dealing with disputes with staff.
Although more fluid that it once was, a partnership has to be thought of as a long term commitment.
New contract impositions from government which lead to decreased practice income and there are concerns at times- particularly in England- whether long term general practice as it stands is viable.