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Commentary by Martina Stanley

We seem to be facing a breakdown of trust between practice owners and GPs (and vice versa). The consequence is that more and more GPs are unwilling to commit to a practice and often will move after a few months.  As a result, practice owners lose faith and respond by trying to impose tighter contractual conditions.

As each side loses trust in the other, they take actions that may result in a further breakdown of trust – creating a vicious cycle that could become a major issue for our industry.

Although I am using broad generalisations, I will try to highlight some key areas of the crisis we see developing in the table below.  I know that life is much more complex, but by over-simplifying the situation, I may be able to illustrate my point.

GPs Practice owners
Feel insecure because there is no incentive for practices to limit the number of GPs they employ Feel ‘burned’ because they have invested a great deal in GPs who have then left after a short time with no warning
Believe that practices don’t adequately share the risk.  They feel they are taking all the risk because they are paid on a percentage rather than a salary Feel like they are carrying all the cost of overheads but some GPs don’t seem to appreciate it
Can’t offer salaried positions because they fear that GPs wont’ be motivated to see as many patients if they have a guaranteed income
Are less loyal because they feel they must look after themselves Don’t invest in GPs until they are certain they will stay, but then risk losing them because they are unhappy
Have worked hard to achieve their goals and in the case of OTDs have been treated poorly by ‘the system’. Feel that ‘the system’ is letting them down as financial supports through PIPS, SIPS and Medicare billings continue to diminish
Don’t fully integrate into the new practice ‘with both feet’ and work between two or more practices to mitigate risk Are putting increasingly strict provisions into contracts to try to tie GPs to their practice
Are unsatisfied because they aren’t getting the patient base and see it as the practice’s responsibility to provide patients See it as the GPs responsibility to make an effort to bring patients back to the clinic by providing exceptional care
Are losing income because they bounce from one practice to another instead of committing to building a strong patient following Find it more and more difficult to operate a viable practice – partly because of lack of a permanent workforce and the need to increase the conditions offered to GPs.

What is the solution?

I don’t think there is a simple solution. But we believe that we must work on re-building trust starting from our own circle of influence.  Each and every one of us can take action to start rebuilding trust.

As recruitment specialists, we try to point GPs toward the practices we know we can trust.  We ask GPs to take the leap of faith and give the practice a proper chance to prove what is possible. We ask them to go the extra mile in working to establish a patient base.  At the same time, we rely on practice owners to do the things that will build trust on their side by providing an honest assessment of the situation and being ‘straight’ with their GPs.

It is possible to re-build trust – but it isn’t easy.  We all need to work on it.