While there are horror stories about PMs becoming partners in a practice and subsequently losing everything as relationships turned sour and the ‘business’ imploded, many in this business are questioning whether now is the time to make the jump from salaried manager to managing partner. So what are the pros and cons when considering an offer to become a partner?

The reasoning

An estimated four per cent of UK practice managers are partners in their practices but this number is forecast to grow in the coming months. And to the layman it makes sense; most practice managers are already crucial to the day-to-day running and development of their practices. Many practice managers have also been at practices for a number of years, so they know the place inside out.

What’s more, if you look at the role of a practice manager and the current structure of practices, if a practice loses a PM it can be more disruptive than a GP moving on. Offering a PM a partnership is therefore a great way to recognise, retain and reward these vital cogs in the practice wheel.

Profit from the practice

The potential advantages of being a partner start with the potential to benefit from the profits of the practice. The motivation to succeed and manage budgets is there but it’s not all positive – have a bad year and there’ll be a reduced profit share for a non-clinical partner. The PM partner sacrifices the certainty of a salary in exchange for the potential of a larger windfall.

Along with financial rewards, lack of recognition of status is something PMs often complain about. Becoming a partner provides the desired recognition. Of course this only works if the other partners within a practice – usually GPs – actually recognise and treat practice managers as equals. Given comments on the Practice Index Forum, this is far from guaranteed.

When all is said and done, there’s no reason why GP practices shouldn’t be treated like any other business – that means senior management should have a combination of different talents. Treating, rewarding and including a PM as the managing director can bring benefits to the practice. You run the business and let the clinical partners get on with their roles.

Taxing times

Back to finances and, because a practice manager partner is self-employed, they would be taxed accordingly. There are certain tax benefits to this status, but the flip side is that being self-employed means doing away with employment rights and other related benefits that go with being an employee.

This is something that should be carefully weighed-up when considering an offer of partnership. It’s also worth looking into the work involved with this and if any professional help would be needed.

Liability

As with everything in primary care, there are some downsides. Crucially, each partner in a practice is jointly and severally liable along with all other partners for the obligations of the practice. On its website, a law firm that specialises in GP practice legalities says that “a third party owed any form of obligation by the partnership can look to any one or more of the partners to satisfy all or any part of the liabilities owed to them by the partnership”. They cite a bank as an example where there are borrowings. This is well worth taking into account when considering becoming a partner.

That’s why it’s always a good idea to seek an indemnity from the other partners so that if they end up with any liability arising from their partnership, the other partners would make good the loss suffered by the non-clinical partner. Anecdotal evidence suggests that only GP partners serious about making a practice manager partnership work will grant this. Indemnities only work if the other partners can actually pay up, but it’s a good start.

While formalising agreements, it could also be worthwhile putting down in writing a clear division of responsibilities. This is where a partnership agreement comes in. This could include how decision-making will be undertaken within the practice, what should be left to clinical partners and how decisions should be recorded for future reference. Above everything else, the agreement should be custom-made to reflect the presence of non-clinical partners within the practice.

Just as recognition was noted above as a positive, a negative can come from joining the ‘board’ of a practice. As was noted on the thread about PMs becoming partners on the Practice Index Forum, as a senior manager, PMs can stand apart from the partners and staff and give a balanced view on strategy. As a partner it would be harder for direction to be unbiased and, even if it was, it might not be perceived as such and therefore might trust be lost? That’s a tough hurdle to overcome.

Uncertainties

Another issue (there are many!) to consider is the perceived lack of direction for primary care. Some suggest the government’s preferred route is to steer away from partnerships towards a more corporate model of large multi-site practices and practice federations. This uncertainty – as well as the current workload – could be why so many GPs are opting for salaried positions they can walk away from more easily than partnerships. More information on the future of primary care has been promised by the government in a few weeks, so it may be worth delaying a decision until then.

Weigh up the options

There are some genuine concerns surrounding PMs becoming partners but it can and does work for many. It’s perhaps possible to sum up by saying the rewards can be greater for PM partners, but so too can the risks. Fully weighing up the options and seeking professional advice where required is the only way forward before making that big decision!

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