The small business model of GP practices is ‘not fit for purpose and is inhibiting change’ according to a House of Lords Committee on NHS sustainability, suggesting that NHS England look into alternative models.

The committee’s conclusions echoed evidence given by Dr Clare Gerada, former chair of the Royal College of General Practitioners (RCGP), who was one of a number of senior healthcare figures to give evidence.

The committee also asserted that there is a need to adapt the ‘contractual basis’ of the primary care model to ensure its future flexibility.

‘In the NHS we are not good at business model innovation,’ said committee witness Lord Darzi, an Imperial College London academic who specialises in health innovation. ‘There are many business models that you can use to ignite the interest in primary care, whether they are partnership or employment models,’ he said.

Committee members recognised the resistance to forming federations in general practice, while some witnesses gave qualified praise of the small business model.

‘Whilst personally I love the partnership-led model of general practice, I know it is not likely to be fit for the long-term future’ said current Chair of the Royal College of General Practitioners, Dr Helen Stokes-Lampard, noting ‘we have to have local solutions for local problems.’

The committee concluded by recommending that NHSE, the Department of Health and the GP profession conduct a review examining alternatives to the small business model and their contractual implications. They said the review should assess the merits of engaging more GPs through direct employment, reflecting arrangements elsewhere in the NHS.