A new ownership model for primary care
Appointing practice managers as equity partners could significantly improve the long-term survival of smaller GP surgeries, according to new research.
A study by the University of Manchester and the University of Calgary found that practices bringing non-clinical managers into partnership roles are markedly less likely to close or merge. The findings are published in the Journal of Health Economics.
The research comes as the number of GP partners – the self-employed clinicians who own and operate most practices in England – continues to fall, concentrating managerial and financial pressures on fewer individuals.
Fewer closures, stronger staffing
Under NHS contracts, practices must have at least one GP partner, but other partners do not need to be clinicians. The study suggests that expanding non-clinical ownership, particularly to experienced practice managers, may strengthen sustainability.
By 2022, 335 practices in England had a manager partner, up from none in 2015, covering around 7% of registered patients.
Analysing 37,660 practice-years across 5,026 practices between 2015 and 2023, the researchers found that appointing a manager partner was associated with:
- Increased numbers of direct patient care staff (excluding GPs and nurses)
- Growth in administrative teams
- Larger patient list sizes
- Higher income from non-core NHS services
Crucially, these practices were significantly less likely to close or merge. There were no adverse effects on GP or nurse staffing, GP turnover, care quality, patient satisfaction or access.
Easing pressure on GP partners
Dr Michael Anderson of The University of Manchester said “shared GP and manager partnership has the potential to reduce risk of closure of practices while easing GP partners financial and administrative burden.”
Co-author Dr Sean Urwin noted that as GP partner numbers decline, “the managerial and financial burden of operating a practice is placed upon an increasingly smaller number of GPs,” arguing that non-GP partners can provide complementary expertise in business management and operations.
The researchers suggest that manager partners may help smaller practices retain independence rather than being absorbed into larger organisations – offering a pragmatic response to mounting workforce and financial pressures in primary care.
Funded by the National Institute for Health and Care Research Policy Research Unit in Health and Social Care Systems and Commissioning, the study points to a structural shift that could quietly reshape the future of general practice.
