Who owns a GP practice in the UK?
Your local GP is a familiar presence, but how much do you know about who owns it and how it's run? We explain how GP practices are structured and funded and how things have changed.
GP practice ownership in the UK explained
In the UK, most GP practices are owned and operated by general practitioners, often in a partnership arrangement. These GP partners are typically self-employed and share the responsibilities of running the practice, managing staff, and ensuring patient care.
How a GP surgery can operate depends on the type of contract the practice has with the NHS. The most common contract is the General Medical Services (GMS) contract, which covers around 70% of GP surgeries. Personal Medical Services (PMS) contracts offer more flexibility and are tailored to meet local health needs, while Alternative Provider Medical Services (APMS) contracts allow non-traditional providers like private companies, charities, or community groups to operate GP services.
GPs provide primary care services, meaning they're the first stop for most health issues in the UK. Your GP can provide treatment or refer patients to other clinicians if needed. GP surgeries offer various services, including medical advice, prescriptions and vaccinations.
A general practice typically includes more than one GP and other qualified staff. You might have an appointment with a nurse practitioner, many of whom are trained to issue prescriptions. Some practices also have in-house pharmacists, physiotherapists and blood testing.
When the NHS was founded in 1948, most GPs worked from a clinic at home rather than a separate building. The NHS built on this model by offering GPs NHS contracts rather than trying to privatise them completely, which led to the current general practice structure.
Most GPs in the UK work as part of a partnership, where the GP is also the practice owner. There are normally at least two GP owners in each practice. Each practice has a contract with the NHS to serve a specific practice area.
Each practice is a small to medium-sized business with only one client: the NHS. NHS England is responsible for commissioning medical care, but over time, it has delegated more primary care commissioning to local clinical commissioning groups (CCGs). National guidelines still exist to ensure each CCG follows the same principles. Each practice signs up for a GP contract to provide primary care. The contract sets out details of funding and what services the practice offers.
GP partners own the business and typically have a partnership agreement governing their business relationship. While GP partners run the practice and employ staff, not all GPs must be partners. Salaried GPs work for the practice but don't own a share.
As mentioned, each practice is a separate business run by GP partners, meaning each partner is self-employed. Each GP partner invests a capital sum in the practice. They deliver care, ensure patient safety, and manage budgets and staff. While staff employed directly by the business have specific responsibilities, the GP owners supervise all the administrative and financial operations.
As mentioned, each GP surgery has an NHS contract. A separate general practice partnership agreement governs the business relationship between the partners.
The partnership agreement sets out each partner's duties and responsibilities, as well as the decision-making process and practice structure. It also includes financial details such as how profits are shared as GPs aren't employees, so they don't receive a salary. As GPs are self-employed, they don't have an automatic right to holiday pay, sick pay, or parental leave like salaried employees do. The contract confirms what they're entitled to. The contract should also include grounds for removal and confirm what will happen if a partner decides to resign or retire. Resignation and retirement can be complex, as partners own a share of the business.
While each practice is a business governed by a partnership agreement, it provides health services under a GP contract with the NHS. The practice enters into a contract with NHS England or a CCG, which commissions healthcare in a specific geographical area.
Several types of contracts exist, and terms vary depending on a practice's services and the local population's healthcare needs. The contract determines how the practice operates and influences GP surgeries' payments.
Types of contract
There are three different types of contracts an NHS GP partnership can have. GP practices can only offer NHS care if they have one of these contracts and they form the basis of all the services a practice provides.
Each contract varies in its' terms and also sets out who can operate a practice. The three contracts are as follows.
The GMS contract
The GMS, or General Medical Services contract, is the most commonly used contract, with around 70% of GP surgeries signed up. It's a standard contract which NHS England negotiates with the General Practice Committee of the British Medical Association each year. The same terms and conditions apply to every surgery, although NHS England and local CCGs commission services separately in each area.
The PMS contract
The Personal Medical Services contract is similar to the GMS, but it offers more flexibility. It allows healthcare commissioners to tailor services to suit their local communities. Commissioners negotiate each contract with local providers while considering national guidelines and standards. The PMS contract is gradually being phased out.
The APMS contract
APMS stands for alternative provider medical services, and it allows organisations such as private companies, charities, and community groups to run surgeries.
This type of contract covers a broad range of healthcare services. While a surgery typically covers a local area, commissioners can use APMS contracts to provide medical care to a specific group, such as homeless people. APMS contracts have enabled private sector companies to buy and operate surgeries.
Contract terms
Contracts provide essential information about how each practice operates, who it serves and the legal requirements it must meet. Each contract has a set of core requirements, and a practice can add further services if it chooses to.
The core contract
Every general practice covers a specific area and provides essential medical services set out in the contract. GPs must keep a list of the patients registered at the practice. The contract also sets out circumstances when they can remove a patient from their list.
The contract is also there to protect patients, ensure services are safe, and give patients a say in how the practice operates. It ensures each practice cooperates with regulatory bodies such as the Care Quality Commission and adheres to official standards on a variety of measures, including complaints handling, clinical processes, and insurance.
Additional services
Many practices add services to their core contract according to their local community's needs. Contracts can include direct enhanced services that commissioners must offer to all GPs or local enhanced services that vary depending on local needs. We'll look at the types of services a contract can cover shortly.
Contract services
GPs can offer many healthcare services, from medical advice and prescriptions to minor surgery. Contracts specify which services are essential and which are optional. They also specify core opening hours.
There are three different types of service:
- Essential services
- Services with an opt-out provision
- Enhanced services
Essential services are non-negotiable and include health advice, diagnosis and treatment, referrals and core opening hours of 8.00 am to 6.30 pm, Monday to Friday, apart from bank holidays.
Contracts generally assume that GPs will offer an out-of-hours service and additional services such as minor surgery, cervical screening, or vaccinations. However, practices can opt-out if they wish. Each local commissioner must ensure patients can access medical advice out of hours if their GP doesn't offer it.
Additional services are optional, but standard contracts state that every practice must have the opportunity to sign up if they want to. Services can vary widely but can include health screening, mental health support or care for patients in nursing homes.
Some GPs can also attract extra funding by training medical students.
General practice funding is complex and comes from various sources.
Practices receive funds based on their essential services and whether they've opted in or out of services such as an out-of-hours service. It's known as the global sum payment and is calculated based on the number of patients registered at each practice. The figure is also weighted, using the Carr-Hill formula, based on the following factors:
- Patients' age and sex
- Whether patients have any additional needs
- The number of patients in nursing homes
- Local staffing costs
- Turnover in the patient list
- Whether the practice is in a rural location
A surgery receives additional income if it offers enhanced services. It can also charge privately for services such as travel vaccinations, sickness certificates, or medical reports relating to injury claims or holiday cancellations. The surgery can sublet rooms to other health providers, although its NHS contract will include clauses affecting how it can use its premises.
The Quality and Outcomes Framework provides an additional source of income and incentivises GPs to reach performance targets to earn points. The framework has five main components and encourages GPs to improve the quality of care they provide, participate in public health services, and support patients with various clinical conditions. For example, a practice can earn points if it helps its patients give up smoking, come for their cervical screening test, or keep their vaccinations up to date. At the end of each year, a surgery will receive a payment based on the points earned.
A partnership is a private business. GPs can be held personally responsible for debts and losses, meaning they must ensure the company's financial side is managed correctly. The funding they receive goes towards paying for staff, medical supplies, building maintenance and office costs such as computer systems and stationery. They must also pay their rent or mortgage, although they can usually claim these costs back.
The partners share the remaining income and must deduct their tax, pension and any professional memberships from the payment they receive.
Technically, every practice is independently owned, but aside from a few private services, they only have one contract with the NHS. However, large corporations are buying several practices as part of the same group. As previously mentioned, the APMS contract was introduced in 2004 and allowed third parties to provide GP services. As a result, private companies have bought into primary care.
Which companies own GP practices?
Operose Health is a subsidiary of Centene Corporation based in the USA. Operose acquired around 60 GP surgeries in the UK, mainly in London. However, the company was sold to HCRG Care Group, meaning Operose practices have now changed hands.
Commentators raised concerns that the funding model means that private sector companies will struggle to profit, particularly if they have shareholders to keep happy. This could result in reduced patient satisfaction and lower-quality care. However, surgeries are still subject to CQC inspection and regulation, even when privately owned. There were also worries that American insurance companies could use their investment to learn about the UK healthcare landscape and seek opportunities to offer private healthcare via the NHS.
Babylon Health also set up the GP at Hand service, which provides digital GP appointments to patients via their NHS GP. The service includes video appointments with various medical professionals, including GPs and face-to-face appointments in some locations. They can make referrals and issue prescriptions as your usual doctor would.
Concerns over patient care
We've previously written about a Panorama investigation looking into standards of care at Operose practices in London. Patients complained about being unable to make an appointment, a lack of continuity of care and delayed diagnoses. The investigation found that while a full-time GP technically managed each practice, they often relied heavily on practice associates or physician associates. They can assist GPs but typically work under close supervision on straightforward cases. There were also delays in document processing, including urgent test results.
Online appointments can be helpful for straightforward health issues and are a core part of private health insurance. However, they don't offer continuity of care, so they aren't suitable for anyone with a long-term condition and depend on internet access.
Getting professional help
We hope this guide has helped you understand how GP practices are owned and funded in the UK. If you'd like to learn more about how health insurance can help you access private GP services, contact us for a comparison quote. We'll put you in touch with a regulated broker for tailored advice.
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