When Partnerships Break Down: Navigating Primary Care Conflicts
Why Early Legal Advice is Your Best Investment
Partnership disputes in general practice rarely materialise overnight; they manifest over time, through various means including tensions around workload, commitment to the practice, money, differing views on the practice direction (stabilize, scale up by merger/acquisition, dispose, terminate NHS contract), patient safety concerns, poor professional practice behaviours, and so on. When left unaddressed, ‘annoying but tolerable irritations’ fester and escalate into a conflict that consumes time, causes stress and ultimately costs money because it threatens the viability of the practice itself. At DR Solicitors, we believe there is a more proactive approach which can be taken to mitigate these issues. Too often, practices reach out when relationships have already deteriorated and the only apparent option is formal litigation, when in fact resolving conflicts earlier can achieve more sustainable outcomes.
The Problem with Waiting before Taking Legal advice
There is a pervasive belief that instructing a solicitor should be a last resort. The concern, understandably, is cost. Legal fees can seem daunting so as a result, partners turn to sources of free advice including ChatGPT. While well-intentioned, these sources are unlikely to provide the specialist, healthcare advice needed to navigate a primary care partnership dispute.
When a dispute lingers on, relationships deteriorate, partner and staff morale plummets and good people leave. Before long, the practice has lost its resilience and it is unattractive to incoming partners. The good news? All of this damage can be avoided with the right, strategic legal advice at the start and sticking laser-focused to the goal.
Preparation Before the Meeting
When conflicts arise, the instinct is often to call an urgent practice meeting. This is rarely wise without preparation. Walking in without a clear agenda, defined objectives and an understanding of your legal position is a recipe for escalation.
Before any meeting, consider what outcome you actually want and take advice on your legal and commercial options at the outset. The right advice can hugely improve your negotiating leverage. Are you seeking to preserve the partnership, or is separation the best path? Do you want changes to working arrangements and profit shares? Next, understand your legal position. Review your Partnership Deed and the rights it creates. If you operate without a formal Deed, you are governed by the Partnership Act 1890, which may not reflect your intentions. Taking legal advice at this early stage is invaluable because a specialist solicitor can help you assess your position so you can approach negotiations with confidence and make informed, sensible decisions.
Every meeting should have a written agenda and clear minutes. Remember: everything you put in writing yourself is potentially disclosable; privileged communications with your solicitor remain confidential.
Choosing Your Dispute Resolution Route
If informal negotiation fails, you will need more structured processes. The three main options are mediation and, rarely, arbitration and court proceedings.
Mediation is a voluntary, confidential process where an impartial third party, known as a mediator, facilitates agreement and communication between parties, aiming to find a mutually agreeable solution for all. It is typically faster, less expensive and preserves relationships because it is collaborative rather than adversarial. Given there is no goodwill in a medical practice, if a dispute has reached this stage (most do not) the case is settled at mediation
Arbitration is more formal but the key positive (in comparison to the public courts or the Employment Tribunal) is that the arguments remain private. It is essentially a ‘private court’ where an arbitrator issues a binding decision. Most GP Partnership Deeds specify arbitration, and you can choose an arbitrator with healthcare expertise to fit the dispute. So you can appoint a healthcare surveyor to arbitrate a surgery valuation dispute or a healthcare accountant to arbitrate a financial dispute. But we work hard to settle a dispute before we get to this point because of the fact that there is no goodwill in an NHS practice so in most cases, the costs are prohibitive.
Court proceedings are heard in the High Court which is a public forum, and therefore the world can read about your dispute. It is slow because of the backlog in getting a hearing pencilled in, expensive and adversarial. It tends to destroy remaining relationships so in our view Court proceedings for a private GP partnership dispute should generally be a last resort.
Why Early Instructions to a Healthcare Lawyer can save Money
Instructing a specialist, primary care, dispute resolution solicitor early reduces your business risk and your costs. Early advice helps you avoid tactical errors: ill-advised emails and social media posts, verbal outbursts that are not thought through and most importantly, failing to follow the dispute resolution procedures set out in your Partnership Deed. You paid for a Partnership Deed so use it, and if you do not have a Partnership Deed in place then you clearly have a high risk appetite! Our team of highly skilled GP dispute resolution lawyers can quickly assess whether your GP or non-clinical partnership dispute is worth pursuing and identify the most appropriate route. Sometimes the best advice is to compromise early; sometimes it is to stand firm and hold out for a better deal.
Get in touch
Whether you are facing an emerging dispute, navigating a difficult partnership conversation, or simply want to review your Partnership Deed, our specialist team is here to help. The earlier you reach out, the more options you have and the lower your costs are likely to be. Contact our Primary Care team today here — the sooner we talk, the more we can do to help.
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The Neighbourhood Health Framework: Key Takeaways for Primary Care Providers
The NHS is undergoing one of its most significant structural transformations in recent years. The recently published Neighbourhood Health Framework builds on the 10 Year Plan and signals a fundamental shift in how healthcare services will be commissioned, contracted, and delivered. For GP practices, PCNs, and other primary care providers, understanding and planning for these changes is essential for survival.
At DR Solicitors, we have been working closely with primary care clients to help navigate the emerging neighbourhood landscape. This Framework brings together much of what we have observed, whilst raising important questions that providers must consider urgently.
A Paradigm Shift: The Major Changes
The end of PCNs as we know them
Perhaps most striking is the near absence of any reference to PCNs. The sole mention confirms that the government “will consult on how primary care networks might evolve into SNPs (Single Neighbourhood Providers).” This leaves a substantial question mark over services and funding currently contracted through the PCN DES.
In practical terms, PCNs will become “Neighbourhoods.” While many will operate on an identical footprint to existing PCNs, others will not. This transition from a network to neighbourhood model represents a fundamental change in the legal and contractual architecture of primary care.
A New Hierarchy of Population-Based Contracts
Until now, primary care contracts (GMS, PMS, and APMS) have been the only truly population-based contracts in the NHS. The framework introduces a new hierarchy of 3 new population based contracts: Single Neighbourhood Contracts (SNCs) for populations of 30,000-50,000; Multi Neighbourhood Contracts (MNCs) for around 250,000; and, at the apex, Integrated Health Organisation (IHO) contracts covering one to three million people. The government intends these to be “nested” within a coherent geographical hierarchy, creating organisational and legal complexity that providers must plan for.
The Implications: Risks and Opportunities
Funding Migration and Loss of Control
The most pressing concern is that PCN (and possibly also some Enhanced Service) funding will migrate into SNCs. Critically, whoever holds the SNP contract will control this funding. Currently, GP practices are the prime contractors under the PCN DES, but in a neighbourhood world they risk becoming subcontractors to the SNP. Our assessment is that GP practices & PCNs risk losing 25%+ of their combined income to the Single Neighbourhood Provider.
Practices who do not secure access to these contracts risk becoming financially unviable. Unlike the PCN DES (which is exempt from procurement rules as an Enhance Service), neighbourhood contracts may well be open to competitive tendering, and so it is critical that PCNs plan for how they will bid for and deliver these contracts – even though the details are not currently fully understood. With the notable exception of single practice PCNs, most PCNs lack legal personality and so will not be able to hold these contracts themselves. PCNs/Neighbourhoods should therefore urgently consider either setting up their own PCN/Neighbourhood company, or consider whether they are comfortable being a subcontractor to a third party, such as a federation, who controls the SNC on their behalf.
Opportunities Within the Hierarchy
There are significant opportunities within the new contract hierarchy for those willing to organise appropriately. GP Federations are generally around the population size of most MNPs, so they would be well placed if they ensure they are appropriately ‘nested’ geographically and have established effective collaborative working arrangements with other providers of primary and community care.
Even at IHO level – where contracts “will only ever be held by NHS organisations” (ie Trusts) – the Framework plans routes for “mature neighbourhood providers to lead an IHO through alliances or joint ventures with statutory NHS organisations.” The clear intent is that General Practice should take cornerstone roles at all levels of the population based contracts, but the obvious challenge is that the necessary governance and entities do not generally exist, and complex questions around staffing, data, VAT, insurance and more will all need consideration in due course. Providers who move quickly to establish governance models will be best positioned.
Local Flexibility
In a departure from NHS England’s usual centralised approach, ICBs and local communities will have significant latitude to develop their own contracting models. The immediate emphasis is on local experimentation – different geographies are developing different solutions, and those who engage proactively with their ICB will have greater influence. Again, this may be a real opportunity for local primary care leadership.
Neighbourhood Health Centres (NHCs)
NHCs represent a far more ambitious vision than the traditional GP surgery. They aim to “bring together GP services with community, local authority, civil society and VCSE sector services,” including co-location with family hubs, food banks, and employment support. As ever though, the problem is finance. Wave 1 (2026-2027) will focus on repurposing existing NHS Property Services and LIFT estates in deprived areas, but given the well-known problems with service charges in many of these buildings it Is hard to see how repurposing can work without first addressing these historic costs; future waves are supposed to include new builds funded through public-private partnerships, but we will have to wait and see how a building incorporating the voluntary sector could ever be financed in this way.
Practical Steps for Providers
Every strategic decision must now be considered through the neighbourhood lens. Providers must urgently consider how to contract for neighbourhood contracts and how their estate fits within the NHC model. Now is a good time to reconsider your PCN operating model, and practices with service charge disputes with NHS Property Services or CHP may find this an advantageous timing to negotiate.
The NHS is moving decisively towards neighbourhood-based commissioning. This creates opportunity for those who embrace change; for those who do not, the consequences may be severe. For further thoughts on the impact of these changes, please listen to our recent webinar on Preparing for Neighbourhood Contracts, and please do get in touch here to discuss your particular practice, PCN or Federation needs.
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Webinar: Preparing for Neighbourhood Contracts
In this webinar, Nils Christiansen from DR Solicitors and Guy Vine from MHA discuss issues surrounding the preparation for Neighbourhood Contracts. This fascinating webinar covers a variety of topics, including an overview of the neighbourhood and multi-neighbourhood models, challenges, opportunities and impacts, as well as what PCNs and Practices can do to prepare.
If you would like to get in touch about any topic covered in the webinar, you can do so here.