Nuffield Trust 19 July 2016
- According to research drawn from a 15-month study of large-scale general practice organisations in England, three quarters of English practices have now joined large-scale GP organisations, formed to help cope with rising pressure and policies demanding longer hours and new services. This report discusses the factors influencing collaboration in general practice.
- While these organisations can help to sustain general practice in the face of intense financial pressure and shortages of doctors and nurses, they have so far made limited progress in expanding into new services, and taking on a strategic role in redesigning care.
- Key findings are as follows:
- This agenda is well underway across the country, with almost three-quarters of general practices already in some form of collaboration with others, almost half of which formed during 2014/15. The major reasons for forming were to ‘achieve efficiencies’ and ‘offer extended services in primary care’.
- Larger scale has the potential to sustain general practice through operational efficiency and standardised processes, maximising income, strengthening the workforce and deploying technology.
- However, scaling up will take a lot of hard work and cannot just be left to a few heroic leaders. All GPs will need to play a part in making these new organisations successful.
- The evidence that these organisations can improve quality is mixed. Patients had differing views about the benefits of large-scale organisations. Some appreciated increased access, while others were concerned about losing the close relationship with their trusted GP.
- The case study organisations had established high-quality specialist services in the community which were popular with patients, but were delivered at relatively small scale. Trust and close engagement between practitioners and commissioners were very important for successful implementation. CCGs had to manage the tension between supporting large-scale organisations to develop while also managing conflicts of interest.
- The report offers a series of practical insights and lessons for general practitioners as well as important lessons for policy-makers, national leaders and commissioners.
