“Withering” GP partnership model threatens provision of general practice, experts warn

Government plans to improve patients’ ability to see their GP are at risk due to a dramatic fall in the number of GP partners, new analysis reveals today.  

The Nuffield Trust shows that, after years of steady decline, GP partners are now in a minority among fully qualified GPs. Meanwhile, the number of GP surgeries has dropped by a fifth in 10 years and the number of GP partners under the age of 40 has plummeted by 53% since September 2015.  
 
The think tank says this raises serious questions about the sustainability of the traditional partnership model of general practice in operation since 1948, whereby GP partners operate as self-employed contractors bearing both the risk and reward of their partnership’s performance. 

In a policy paper aimed at shaping the government’s promised reforms to general practice, the Nuffield Trust calls on policymakers to proactively develop and test alternatives to the partnership model, alongside measures to shore it up in areas where it is working well. The paper comes just days after a new contract has been agreed by the government and the GP profession, with plans afoot for further reform as part of the longer-term contract negotiations about to begin. 

Options for reform discussed in the paper range from expanding existing alternatives to partnership (such as hospitals running GP surgeries, or turning partnerships into employee-owned trusts) to more radical new models – such as creating new NHS-run organisations to deliver general practice and offer salaried NHS employment to multidisciplinary GP teams. 

Key findings from the Nuffield Trust paper include: 

• The number of GP partners has dropped by almost 25% since 2015, from 24,491 in September 2015 to 18,425 in December 2024. In June 2024 GP partners were in a minority among fully qualified GPs for the first time.
• Over the same time period, the number of salaried GPs has increased by 81% – from 10,270 in September 2015 to 18,557 in December 2024.
• The number of GP partners aged under 40 has fallen by 53% from 4,676 in September 2015 to 2,210 in December 2024. The only age group with growth in partner numbers is the over 60s, which grew from 2,429 in September 2015 to 2,662 in December 2024.
• The number of GP surgeries in England has fallen from 7,623 in September 2015 to 6,227 in December 2024 (a drop of 18%). 

Proactively looking at alternatives to the partnership model would be a departure from the current approach, which has been to allow different models of general practice to spring up without top-down direction from the government, whilst the partnership model has withered in many areas. The Nuffield Trust says that the consequences of this approach mean that the provision of general practice in local areas is threatened.  

Commenting on the paper, Dr Becks Fisher, Director of Research and Policy at the Nuffield Trust said: 

“The model of general practice that we have relied upon for the past 75 years is declining. For reasons that aren’t going to change any time soon, many younger GPs are simply not in a position to take on the risk and workload associated with GP partnership. 

“Alternatives are desperately needed, but the answer is not for the government to simply abolish the partnership model. Rash moves could dangerously destabilise general practice and undermine provision in areas where partnership is working well. 

“Nor is inaction an option: letting the current model continue to wither is likely to result in more practices closing their doors, with disastrous consequences for patients. Instead, we need a strategy that restores the core functions of general practice and supports whatever models sit behind that – sometimes partnership, sometimes other models. This will mean careful planning and evaluation from the government, working hand in hand with the profession and learning from what is working in different parts of the country.”