Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes

Ownership of English general practices by physicians has been declining for many years and concentrated among fewer physicians. Non-clinical ownership may provide a sustainable alternative structure for general practice. In this study, we provide the first formal evaluation of non-clinical ownership in an English general practice setting. We compile a comprehensive dataset of general practices across eight years between 2015/16 and 2022/23 from a range of sources to investigate the impact of non-clinical ownership stakes on key primary care outcomes, including staffing levels and turnover, patient satisfaction, access, quality of care, reimbursement for non-core services and total patient list size. Employing a dynamic event study design combined with propensity-score weighting, we find practice manager partners increase direct patient care (excluding physicians and nurses), administrative staff numbers, reimbursement for non-core services and total patient list size. However, we find no statistically significant effect on any other outcome. Offering equity stakes to non-physician staff may support practice sustainability by allowing alternative ownership structures.