Running Water and the Future of General Practice Partnerships

Dr Will Mackintosh is a GP partner and trainer who has been working in West Wales for over 10 years. Will joined Yma as Interim Clinical Director from October 2022 to January 2023, providing clinical leadership to ensure that the core values of primary care are at the centre of our projects for the benefit of patients across Wales. We asked Will if he would be interested in sharing some thoughts around the role of general practice and the partnership model.

As a GP partner I can attest to the significant challenges facing primary care in recent years. These have been well documented alongside the other struggles the NHS has faced. Both at the height of the pandemic and during this winter, where along with all our NHS colleagues we have faced the greatest demand for services we have ever seen. The partnership model has been under particular scrutiny with an internal debate about its future and increased political posturing about what the future should look like.  Part of the struggle for GP partnerships is the unique position they hold in British public life. The ubiquitous image of the personal generalist doctor is part of the national consciousness. A reputation built on availability, usefulness and kindness. And perhaps it is this reputation that so often becomes the undoing of GPs in the public eye. The public rightly expects that GP services should be like running water, turn on the tap and there it is, clean and safe. The partnership model has been the reservoir from which primary care services have flowed for generations.  

While the politics of partnerships dominates the headlines, if we re-examine the evidence for provision of good health care, established in the latter part of the 20^th century by Barbara Starfield among others we find that the running water analogy is well deserved. Provision of accessible, comprehensive and continuous primary care in communities is associated with improved outcomes in a wide range of measures. Whether it is infant mortality or cancer survival, primary care delivers outcomes across the board when it is well funded and designed.

With this in mind, we might return to the UK and consider the history of the GP partnership model within the NHS. From its outset there was a suspicion of the motivation of independent GPs who were concerned about the implications to their income from a free at the point of care service. In my view this has set up a generational and inherited problem which on both sides can hamper progress in delivering a perfect primary care model. That said the partnership model does at times, come very close. At its best the partnership model is a kind of grass roots ‘cottage industry’ run by expert generalist doctors who, in many cases, provide fantastic care on a shoestring. The contrast with the drama provided by the life-saving hospital is at times both the partnership model's strength and its undoing. These systemic issues mean that when things are going well, GP practices go under the radar, and when things are tough, it is the fault of the GPs rather than the system itself.  

Even in these times of enormous pressure there is still cause for optimism. In Wales, it is in these spaces that Yma aims to operate. Whether it is supporting practices with provision of IT solutions, cluster development or influencing referral pathway redesign, change is possible. During my time as interim clinical director, it has been my goal to ensure that as an organisation, we are continually driven by the evidence for good primary care provision. Whether this is to play a part in preserving what we have or ensuring that a primary care outlook finds its way into new areas.  

Whatever your views of the partnership model, there is no arguing with the evidence. The history of the partnership model tells us that it has never been allowed to reach its potential. We are now collectively faced with not a political choice but one which is as important as the provision of running water. We either support the partnership model with adequate funding and resources to firstly make it a doable job once more, or we re-design a new model which gets even closer to the vision of general practice described by Barbara Starfield. In my view it is both practical and sensible to avoid a project which reinvents the wheel. A new deal for GP partners would help to refill the reservoir and is the best option for patients.  

Yma has been working with GPs, practice managers, health board staff and clusters to provide support and innovation to the complex problems faced by primary care and the system as a whole. If you would like any further information about the work we are doing, please get in touch at yma@dymani.cymru.

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