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Hospital takeover of GP practices leads to better access to specialist care, finds study

by Awil Mohamoud
4 December 2020

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GP practices taken over by hospitals have been able to offer patients access to a wider range of healthcare professionals at their local practice, a National Institute for Health Research (NIHR) study has found.

The study examined interviews with 52 staff members across three GP practice sites in England and Wales that became integrated with hospital organisations after a takeover.  

The researchers found that the practices were increasingly able to offer patients the opportunity to consult with healthcare professionals other than their GP, such as those who have specialist training in areas including diabetes and joint pain.

The report added that it was ‘hard to tell’ the extent to which this change might have occurred without vertical integration, but said it would have been ‘harder to introduce’ without ‘financially stable’ and ‘fully staffed’ practices.

Keeping practices open

The researchers found hospital buyouts – seen in several locations across the country since 2015 – have kept open practices that would have otherwise closed, and have provided a ‘more stable financial platform’ than individual practices run as separate businesses.

This ‘stabilising’ of practices has also given them the ‘opportunity to progress with some changes to patient care’, the study found.

This included introducing other innovations such as sharing information in real time across primary and secondary care and targeting high-risk patients with multiple morbidities.

For example, one of the case study sites was able to develop its own database to identify and track high-risk patients across primary and secondary care to share real-time information with practitioners across the care interface. 

One of the interviewees said: ‘It’s like a dashboard: so it tells us what patients have been admitted overnight, what procedures they’ve had done, and we get a copy of that each day and the GPs look at it and think, ‘Oh, Mrs so-and-so was in there last night; I might give her a call and see if she’s OK.’ So it links the care up better.’

Financial risks

The study also found that financial and other business risks associated with running a general practice had been removed from the GPs.

The hospital organisations were better able to deal with those risks due to their much greater size and broader portfolio, it was suggested, and could offer benefits such as staff training and career development opportunities, as well as job security, which itself ‘increases their chances of recruiting and retaining primary care staff’.

However, the report found the ‘divide in the NHS’ between primary care and trusts or local health boards running hospitals ‘has not been fully overcome’, with many GP practices choosing to remain outside vertical integration arrangements, including those in areas struggling with recruitment. 

Impact on practice staffing

The researchers found that vertical integration had led to the development of multi-disciplinary teams, with some increase in providing specialist outreach from hospitals.

All practice staff at the three sites benefited from increased access to training, which included the opportunity for GPs to develop specialist interests, the report said. 

The removal of financial risk for GPs also meant they could ‘focus on clinical work’, and leave running the business to others, which made these practices a ‘more attractive’ place to work, and seemingly helped with recruitment.

In one of the case study areas, the hospital organisation had to invest in the workforce soon after the integration, to make up for the shortage of GPs, according to the report. 

It said: ‘This led to the development of greater and more widespread use of models of multidisciplinary teams working across the local health board area. 

‘As a result, in one area within the local health board, a model was developed to encourage inter-disciplinary working, supporting patients living with complex multi-morbid conditions and reducing medicine prescribing.’

What did the study conclude?

The researchers said the main purpose of hospital takeovers is to stop GP practices having to close, which not only enables patients to continue to have local access to primary care, but also helps manage demands on secondary care – especially emergency services. 

The stable platform it provides also creates the opportunity for subsequent patient care improvements, it added.

The findings indicated that vertical integration may have a role in improving integration of patient care, at least in some areas.

Vertical integration is a ‘valuable option’ to consider when GP practices look likely to fail, suggested the researchers, but said this should not be composed from the top down.