Smaller GP practices that appoint a manager partner are significantly less likely to close or merge, the first study of its kind has found.
The University of Manchester and Calgary researchers publish their study today in the Journal of Health Economics amid a backdrop of dwindling numbers of GPs practice owners-known as partners.
That, say the researchers, puts the managerial and financial burden of operating a practice on increasingly smaller numbers of GPs, with a heightened consequential risk of burnout and stress.
It is funded by the National Institute for Health and Care Research (NIHR) Policy Research Unit (PRU) in Health and Social Care Systems and Commissioning.
Practices in the UK are generally owned and operated by one or more self-employed independent contractors referred to as partners.
Under most general practice contracts with the NHS, there must be at least one General Practitioner (GP) partner at a practice; however, not all partners need to be GPs.
One potential way to provide a sustainable alternative structure for general practice they say, could be non-clinical ownership with practice managers as partners.
The managers, responsible for administration, HR, and financial management, typically handle the business and operational aspects of the practice and do not usually have medical training.
By 2022, the number of practices reporting they had a manager partner had grown to 335, from 0 in 2015, serving 7% of patients registered at general practices in England.
Based on analysis of data from England's 37,660 practice-years from 5,026 general practices between 2015 and 2023, the researchers use a range of sources to investigate the impact of non-clinical ownership stakes on key primary care outcomes.
They found that appointing a manager partner leads to significant increases in full-time equivalent (FTE) direct patient care staff, excluding GPs and nurses, as well as administrative staff numbers and total patient list size.
Practices that appoint a manager partner were found to be more sustainable because they were less likely to subsequently merge or close.
There were no significant impacts on numbers of GP or nurse staff, GP turnover, quality of care, patients' satisfaction and access. And income from reimbursement for non-core services, such as local or direct enhanced service, quality outcome framework payments, and medication administration payments, were higher following appointment of a practice manager as a partner.
Co -author Dr Michael Anderson from The University of Manchester said: "Our study shows shared GP and manager partnership has the potential to reduce risk of closure of practices while easing GP partners financial and administrative burden."
"This ownership model is feasible within many other healthcare systems, where physicians may seek to share with non-clinical colleagues the financial and administrative burden associated with operating practices."
Co-author Dr Sean Urwin from The University of Manchester, said: "As the number of GP partners continues to decrease, the managerial and financial burden of operating a practice is placed upon an increasingly smaller number of GPs.
"While not a like-for-like substitute for GPs, we argue that non-GP partners can alleviate some partnership burdens and offer additional managerial skills.
"Our analysis also indicates that manager partners offer a potential route for smaller practices to retain their independence rather than being integrated into larger organizations."
Co-author Dr Ben walker from the University of Calgary, Canada, said: "The appointment as of practice managers as partners may offer a number of benefits.
"The increase in direct patient care staff in practices that appoint manager partners could be indicative of the manager's efforts to improve the organisational efficiency and performance of the practice.
"With expertise in business planning, they may be better placed and more incentivised to maximise income, leaving more time for GPs to concentrate ion patient care and even potentially slowing the decline in GP partner retention.
"But also, manager partners' skills in HR and financial planning may improve staff organisation and recruitment."
- The paper Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes is available here https://doi.org/10.1016/j.jhealeco.2026.103122
