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

My journey to GP Land!My journey to GP Land!

Qualified Dec 2000Qualified Dec 2000

PRHO, A&E, mandatory 6/12 travelPRHO, A&E, mandatory 6/12 travel

SHO medical rotationSHO medical rotation

Saw the light and moved to VTS (!)Saw the light and moved to VTS (!)

18/12 Airedale VTS18/12 Airedale VTS 6/12 GP Kilmeny with Jim6/12 GP Kilmeny with Jim 6/12 O&G AGH6/12 O&G AGH 6/12 GP Fisher with Alan6/12 GP Fisher with Alan

Completed VTS Feb 2007Completed VTS Feb 2007

Since VTSSince VTS

Feb – June 2007 – Locum workFeb – June 2007 – Locum work

July 2007 – joined Haworth, 6/12 mutual July 2007 – joined Haworth, 6/12 mutual trial period 4.5 sessions a week (job trial period 4.5 sessions a week (job share)share)

Jan 2008 – formally became partner at Jan 2008 – formally became partner at Haworth 4.5 sessions per weekHaworth 4.5 sessions per week

Initially continued locum work alongsideInitially continued locum work alongside

Now 5.5 sessions per weekNow 5.5 sessions per week

My roles within our partnershipMy roles within our partnership

First and foremost primary care!First and foremost primary care!Medical student leadMedical student leadPrescribing leadPrescribing leadOsteoporosis leadOsteoporosis leadCaldicott GuardianCaldicott GuardianFamily planning/coils/implantsFamily planning/coils/implantsAway DayAway DayWebsite developmentWebsite developmentPalliative carePalliative care

Next steps?Next steps?

Level 2 DM clinic?Level 2 DM clinic?

GP training?GP training?

Keep things changing within your rolesKeep things changing within your roles

Keep things interesting!Keep things interesting!

Your plans?Your plans?

What are you doing currently?What are you doing currently?

Your ideal first post after VTS?Your ideal first post after VTS?

What things are you hoping to get from What things are you hoping to get from this session? Any thoughts on areas you this session? Any thoughts on areas you would like to cover.would like to cover.

Why consider a partnership?Why consider a partnership?

Full involvement in practice decisionsFull involvement in practice decisions

Opportunity to shape way practice Opportunity to shape way practice developsdevelops

Opportunity to shape own career more Opportunity to shape own career more easilyeasily

Opportunity for higher incomeOpportunity for higher income

Opportunity to own share of business +/- Opportunity to own share of business +/- premisespremises

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

Why consider an alternative?Why consider an alternative?

Worried about having to make financial Worried about having to make financial commitment to a practicecommitment to a practice

Prefer ease/security of being employed rather Prefer ease/security of being employed rather than self-employedthan self-employed Regulated sick/mat/study leave and payRegulated sick/mat/study leave and pay Fixed holsFixed hols No financial risk – salary setNo financial risk – salary set Less paperwork re tax/NI/pension etcLess paperwork re tax/NI/pension etc

Not ready to commit to staying in one placeNot ready to commit to staying in one place

Not able to find the right practice/role for Not able to find the right practice/role for you at the momentyou at the moment

Not wanting extra time commitment that Not wanting extra time commitment that may be neededmay be needed

Not wanting extra responsibilitiesNot wanting extra responsibilities

What to consider when looking for What to consider when looking for a partnershipa partnership

SizeSize how many partners/salaried GPshow many partners/salaried GPs patients per full time drpatients per full time dr

LocationLocation RuralRural Inner cityInner city Population demographicsPopulation demographics

Basic info re usual working dayBasic info re usual working dayLevel and types of care providedLevel and types of care providedSkill mix – what’s missing and what can you Skill mix – what’s missing and what can you offer?offer?

The “woolly” stuff…The “woolly” stuff…Ethos of the practice – where do their Ethos of the practice – where do their priorities lie?priorities lie? PatientsPatients TimeTime MoneyMoney

What sort of people are they? Do they get What sort of people are they? Do they get on? Will you fit in?on? Will you fit in?What values do they have?What values do they have?How often do they all meet up during How often do they all meet up during working week?working week?

The business sideThe business sideHow progressive/well-organised/in-tune with How progressive/well-organised/in-tune with challenges of continuing changes to GP work challenges of continuing changes to GP work are they?are they?

Approach to division of workloadApproach to division of workload

Who owns the premises?Who owns the premises?

Financial buy-inFinancial buy-in

Practice accounts – will they be available for you Practice accounts – will they be available for you to see?to see?

Partnership agreement Partnership agreement Do they have one?Do they have one? Is it up-to-date?Is it up-to-date?

Most importantly …Most importantly …

What are they looking for?What are they looking for?

What are you looking for?What are you looking for?

Where to lookWhere to look

Local grapevineLocal grapevine

VTS boardVTS board

Local GPs/trainersLocal GPs/trainers

LMCLMC

BMJBMJ

GP/Pulse/DoctorGP/Pulse/Doctor

Local sessional doctor groupsLocal sessional doctor groups

ApplyingApplying

Update your CV earlyUpdate your CV earlyDevelop a template covering letter which Develop a template covering letter which you can individualiseyou can individualiseConsider visiting practice/speaking to PM Consider visiting practice/speaking to PM or a partneror a partnerAsk around for info/gossip about the Ask around for info/gossip about the practicepractice Trainers/other local GPsTrainers/other local GPs Previous GP Regs/locums/salaried GPsPrevious GP Regs/locums/salaried GPs

InterviewsInterviews

Questions they may ask you:Questions they may ask you: Reasons for applying – be clear about what Reasons for applying – be clear about what

you’re looking foryou’re looking for Your main achievements to dateYour main achievements to date The strengths you would bring to the postThe strengths you would bring to the post Any special clinical interestsAny special clinical interests What sort of person are you? How would a What sort of person are you? How would a

friend describe your personality?friend describe your personality? Hobbies/outside interestsHobbies/outside interests

What differences do you see between being a What differences do you see between being a partner and being salaried?partner and being salaried?

Where would you like to see the Where would you like to see the practice/yourself in 5yr time?practice/yourself in 5yr time?

What pros and cons do you see in the What pros and cons do you see in the government’s plans re GP consortia?government’s plans re GP consortia?

What do you see as the most important features What do you see as the most important features of a successful and stable partnership?of a successful and stable partnership?

What have you read recently that has changed What have you read recently that has changed your practice?your practice?

““What would you do” questions:What would you do” questions: Describe a situation where you had to work Describe a situation where you had to work

effectively in a group or team to achieve a effectively in a group or team to achieve a shared goalshared goal

Tell us about an achievement that you are Tell us about an achievement that you are especially proud of because it was difficult or especially proud of because it was difficult or demanding to do demanding to do

Describe a complex problem you have faced Describe a complex problem you have faced and how you resolved itand how you resolved it

In your opinion what is the biggest threat to In your opinion what is the biggest threat to and the greatest opportunity for general and the greatest opportunity for general practice over the next 10 years practice over the next 10 years

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

TRY TO AVOID THE OBVIOUS AND LEARN TRY TO AVOID THE OBVIOUS AND LEARN SOMETHING YOU ACTUALLY WANT TO KNOW!SOMETHING YOU ACTUALLY WANT TO KNOW!

Before acceptingBefore accepting

Gut feeling after interviewGut feeling after interview

Ask to see partnership agreementAsk to see partnership agreement

Ask to see accountsAsk to see accounts

Check whether you need to buy in, if so Check whether you need to buy in, if so when and how muchwhen and how much

Check situation re mutual assessment Check situation re mutual assessment periodperiod

Check plans to draw up new agreementCheck plans to draw up new agreement

AccountsAccounts

Ask to see ideally last 3yr accountsAsk to see ideally last 3yr accounts

Consider independent assessmentConsider independent assessment

How are profits divided?How are profits divided?

Parity issuesParity issues

What income is pooled?What income is pooled?

Provisions for tax, practice accountantProvisions for tax, practice accountant

Who does the accounts?Who does the accounts?

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

What to expect from the 1What to expect from the 1stst year year

Try to get a feel for what will be expected from Try to get a feel for what will be expected from you before you startyou before you startFinding your feetFinding your feetLearning people’s names!Learning people’s names!Adjusting to new IT systems/colleagues/referral Adjusting to new IT systems/colleagues/referral routes etcroutes etcStarting to get an idea of areas you would like to Starting to get an idea of areas you would like to lead on/developlead on/developAllow yourself time to settle in and accept things Allow yourself time to settle in and accept things will take you longer to start withwill take you longer to start with

How to get the most out of it and How to get the most out of it and stay sane!stay sane!

Away Day/practice meeting good Away Day/practice meeting good opportunity to review how things are goingopportunity to review how things are going

Plan ahead re areas you would like to Plan ahead re areas you would like to become more involved in / skills you would become more involved in / skills you would like to developlike to develop

Change tack regularly to keep things Change tack regularly to keep things interestinginteresting

Talk to your partnersTalk to your partners

GOOD LUCK!GOOD LUCK!