Partnerships - the 1st few years how to plan & do it

My journey to GP Land! Qualified Dec 2000 PRHO, A&E, mandatory 6/12 travel SHO medical rotation Saw the light and moved to VTS (!) 18/12 Airedale VTS 6/12 GP Kilmeny with Jim 6/12 GP Kilmeny with Jim 6/12 O&G AGH 6/12 O&G AGH 6/12 GP Fisher with Alan 6/12 GP Fisher with Alan Completed VTS Feb 2007

Since VTS Feb – June 2007 – Locum work July 2007 – joined Haworth, 6/12 mutual trial period 4.5 sessions a week (job share) Jan 2008 – formally became partner at Haworth 4.5 sessions per week Initially continued locum work alongside Now 5.5 sessions per week

My roles within our partnership First and foremost primary care! Medical student lead Prescribing lead Osteoporosis lead Caldicott Guardian Family planning/coils/implants Away Day Website development Palliative care

Next steps? Level 2 DM clinic? GP training? Keep things changing within your roles Keep things interesting!

Your plans? What are you doing currently? Your ideal first post after VTS? What things are you hoping to get from this session? Any thoughts on areas you would like to cover.

Why consider a partnership? Full involvement in practice decisions Opportunity to shape way practice develops Opportunity to shape own career more easily Opportunity for higher income Opportunity to own share of business +/- premises

Opportunity to develop new skills eg Recruitment, interviewing Recruitment, interviewing Dealing with staff disputes Dealing with staff disputes Handling patient complaints Handling patient complaints Understanding (?!) accounts Understanding (?!) accounts Negotiation/decision-making within a team Negotiation/decision-making within a team

Why consider an alternative? Worried about having to make financial commitment to a practice Prefer ease/security of being employed rather than self-employed Regulated sick/mat/study leave and pay Regulated sick/mat/study leave and pay Fixed hols Fixed hols No financial risk – salary set No financial risk – salary set Less paperwork re tax/NI/pension etc Less paperwork re tax/NI/pension etc Not ready to commit to staying in one place

Not able to find the right practice/role for you at the moment Not wanting extra time commitment that may be needed Not wanting extra responsibilities

What to consider when looking for a partnership Size how many partners/salaried GPs how many partners/salaried GPs patients per full time dr patients per full time drLocation Rural Rural Inner city Inner city Population demographics Population demographics Basic info re usual working day Level and types of care provided Skill mix – what’s missing and what can you offer?

The “woolly” stuff… Ethos of the practice – where do their priorities lie? Patients Patients Time Time Money Money What sort of people are they? Do they get on? Will you fit in? What values do they have? How often do they all meet up during working week?

The business side How progressive/well-organised/in-tune with challenges of continuing changes to GP work are they? Approach to division of workload Who owns the premises? Financial buy-in Practice accounts – will they be available for you to see? Partnership agreement Do they have one? Do they have one? Is it up-to-date? Is it up-to-date?

Most importantly … What are they looking for? What are you looking for?

Where to look Local grapevine VTS board Local GPs/trainers LMCBMJGP/Pulse/Doctor Local sessional doctor groups

Applying Update your CV early Develop a template covering letter which you can individualise Consider visiting practice/speaking to PM or a partner Ask around for info/gossip about the practice Trainers/other local GPs Trainers/other local GPs Previous GP Regs/locums/salaried GPs Previous GP Regs/locums/salaried GPs

Interviews Questions they may ask you: Reasons for applying – be clear about what you’re looking for Reasons for applying – be clear about what you’re looking for Your main achievements to date Your main achievements to date The strengths you would bring to the post The strengths you would bring to the post Any special clinical interests Any special clinical interests What sort of person are you? How would a friend describe your personality? What sort of person are you? How would a friend describe your personality? Hobbies/outside interests Hobbies/outside interests

What differences do you see between being a partner and being salaried? Where would you like to see the practice/yourself in 5yr time? What pros and cons do you see in the government’s plans re GP consortia? What do you see as the most important features of a successful and stable partnership? What have you read recently that has changed your practice?

“What would you do” questions: Describe a situation where you had to work effectively in a group or team to achieve a shared goal Describe a situation where you had to work effectively in a group or team to achieve a shared goal Tell us about an achievement that you are especially proud of because it was difficult or demanding to do Tell us about an achievement that you are especially proud of because it was difficult or demanding to do Describe a complex problem you have faced and how you resolved it Describe a complex problem you have faced and how you resolved it In your opinion what is the biggest threat to and the greatest opportunity for general practice over the next 10 years In your opinion what is the biggest threat to and the greatest opportunity for general practice over the next 10 years

Questions you could ask them! How would you describe your practice population? How do you stay in touch with each other during the working week? What plans do you have for how the practice will develop over the next 5-10yr? Why do you enjoy working here and what things about it do you find stressful? How would you describe the priorities of this practice? Over what sort of issues do you tend to disagree and how do you resolve any differences of opinion? What do you enjoy doing outside work? TRY TO AVOID THE OBVIOUS AND LEARN SOMETHING YOU ACTUALLY WANT TO KNOW!

Before accepting Gut feeling after interview Ask to see partnership agreement Ask to see accounts Check whether you need to buy in, if so when and how much Check situation re mutual assessment period Check plans to draw up new agreement

Accounts Ask to see ideally last 3yr accounts Consider independent assessment How are profits divided? Parity issues What income is pooled? Provisions for tax, practice accountant Who does the accounts?

Partnership agreement Must have one – or you’re relying on Partnership Act of 1890! Must be up-to-date or risk “Partnership at Will” Get advice from BMA if any doubts Check sick/mat/pat/study leave entitlements and pay arrangements Check re how assets/income divided Check agreement re decision-making What happens if things break down? How will you be treated during a mutual assessment period?

What to expect from the 1 st year Try to get a feel for what will be expected from you before you start Finding your feet Learning people’s names! Adjusting to new IT systems/colleagues/referral routes etc Starting to get an idea of areas you would like to lead on/develop Allow yourself time to settle in and accept things will take you longer to start with

How to get the most out of it and stay sane! Away Day/practice meeting good opportunity to review how things are going Plan ahead re areas you would like to become more involved in / skills you would like to develop Change tack regularly to keep things interesting Talk to your partners

GOOD LUCK!