General Practice in the UK has long relied on partnerships as the main operational model. These are independent contractors delivering NHS services while running complex healthcare businesses. Partners are not only responsible for patient care but also for staffing, estates, finances, governance and compliance.
Over time, the composition of partnerships has evolved. More and more partnerships now include non-GPs – pharmacists, nurses and, in the majority of these cases, Practice Managers. These Partners share the same risks and responsibilities of running the practice, alongside their GP counterparts. I am personally very proud to be one of them.
While the partnership model has changed to include us, the structures that influence and negotiate the GP contract have not kept pace.
The number of GP Partners has fallen significantly over the past decade, by roughly a quarter since 2015. In this context, practices have increasingly looked at alternative partnership structures to sustain leadership capacity and operational resilience.
New research published in the Journal of Health Economics provides the first formal evaluation of non-clinical ownership in English General Practice[1].
The study, titled “Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes” showed that practices with a Practice Manager Partner were less likely to close or merge, saw increases in administrative and direct patient-care staff (with higher retention rates) and experienced higher income from non-core services.
Crucially, these changes occurred without negative impacts on quality of care, patient satisfaction, access or GP workforce numbers.
This year the Department of Health and Social Care and NHS England expanded stakeholder engagement regarding the next GP contract for the first time to include the Institute of General Practice Management, the representative body for managers working in General Practice. This was the first time that Practice Managers – and Practice Manager Partners – were given the opportunity to directly influence and respond to the government’s proposals for the next contract. There were limitations placed on us, as the formal negotiations can only take place with the BMA’s General Practitioners Committee. But we felt that the operational knowledge and expertise were seriously taken into consideration with regards to the proposals.
Despite our growing presence and demonstrated value, non-GP Partners have no representation within the General Practitioners Committee. And yes, it’s called the “General Practitioners” Committee. However, I attended the special GPC England conference in March 2025, where we met to discuss collective action and heard the Chair of GPC talk about how we needed to protect “General Practice”: the whole team.
Non-GP Partners are not currently permitted to raise, speak to, or vote on motions at GPC conferences. This is despite them contributing financially towards the levy payments that fund these conferences and their representatives.
This is a structural gap. Practice Manager Partners – and other Non-GP Partners – are contract holders. We share legal and financial accountability for delivery, and are responsible for translating policy into operational reality.
This is not a criticism of existing negotiating bodies. GP-led representation has historically been appropriate given the clinical leadership of the profession. However, as partnerships evolve, there is a growing case for ensuring that the full range of Partners involved in delivering the contract have a voice in shaping it.
Representation does not mean having to replace or dilute clinical leadership. Rather, it should recognise that modern General Practice depends on both clinical and operational expertise.
Including Non-GP Partners in discussions around the contract can help to ground policy in operational reality, ensure better alignment between policy and delivery and provide a more unified voice for General Practice.
The aim should not be competing representation, but shared representation, reflecting the collaborative leadership that already exists within many practices across the country. The IGPM is not, and does not seek to be, a trade union. But I, and my fellow Practice Manager Partner colleagues, would relish an opportunity to join one that can represent our interests alongside our fellow Partners. Perhaps it is time for the BMA to consider options to allow our inclusion?
Robyn Clark, Managing Partner, Kingswood Health Centre
Director, Institute of General Practice Management
