Written evidence submitted by Dr Richard Hook (FGP0206)

I am a GP Partner in Wiltshire, and have been for 21 years, since qualifying as a GP. I feel strongly that the viability of the partnership model is being threatened, either unwittingly or deliberately, by NHSE, who do not fully understand the impact of the changes they keep making, and that ICS’s and the latest round of reorganisation do nothing to challenge that perception!

The “barriers to accessing general practice” are simple: there are not enough of us as it is no longer an attractive, sustainable career choice.

Everything else stems from that.

Most of the terms of reference rather assume the outcomes of this report, in my view, but the matter of partnership and its viability is raised, and I would like to respond to that.

The partnership model is not failing because of a shift towards salaried posts, but instead newly qualified GPs are taking salaried posts because they can see that being a partner is unsustainable. It is self-perpetuating. Partners are shouldering enormous, uncapped demand and responsibility, without even the protection of limited liability status that would be afforded in any other professional arena when running a small business. Arbitrary rules mean I could lose my house if my partnership collapses, but I cannot recruit or retain staff due to the work pressure, which I cannot resolve because I cannot recruit, and the only option is for the partners to work harder, but then they burn out and the workload for those left grows again

If the government is serious about partnerships surviving it needs to do several things, and the fact that it has not done either suggests very strongly that the ultimate aim of NHSE is to have partnerships either disappear in favour of a salaried service (which it must know it could never afford) or that those partnerships be taken over by ICS/big corporations.


Firstly, it needs urgently to permit NHS GMS contracts to be held by Limited Liability Partnerships, so that the potential bankruptcy faced by exiting partners disappears. We need a new building, but we’d need to sign a lease of 20years or more, and the partners would have full personal liability for the whole term of that. No wonder a new GP in their 30’s might not want to be a partner…

Secondly, the Government needs to define exactly what NHS care entails and allow GPs to charge for anything above that. For example: extended hours –  if a patient wishes to discuss a routine matter with me on a Sunday afternoon instead of in a routine appointment during the defined NHS GP hours of 8.00am to 6.30pm, why is it not possible for me, as their NHS GP, to offer that option for a fee? As long as we are also available to patients inside my contracted hours, why cannot we elect to offer extra services outside those hours?

Neither of these changes would cost the NHS anything, and would greatly incentivise partnership and lead to increasing numbers, so why are they not implemented? They are so obvious that they must have been raised often in NHSE, and it therefore becomes impossible to escape the view that these changes have not been made exactly because they would invigorate the existing model of partnerships. If this Inquiry truly values partnerships and sees them as playing a big part in the future of NHS general practice, then it needs to explain why these changes have not been made or could not occur.

December 2021