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Large-scale GP practice organisations help with demand but not quality of care

20 July 2016

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Three quarters of GP practices have now joined large-scale organisations to help them cope with rising demand, according to a Nuffield Trust report.

The report, Is Bigger Better? Lessons for large scare general practice, found that while these organisations can help general practice deal with financial pressures and staff shortages, they have not expanded into new services.

By pooling resources, standardising ways of working and bringing in more income, the report found that GP services stabilised.

While there was no evidence to suggest any differences in quality of care compared to the national average, patient satisfaction was mixed.

The report found that some patients voiced concerns about losing the ongoing, trusted relationship with their GP.

Consequently, the report advised large GP organisations to “harness the benefits of larger scale while preserving the localism and ‘expert generalism’ of general practice”.

Staff, however, were said to be “broadly positive” about working on a larger-scale, with administrators and receptionists reporting the highest satisfaction as they valued the training opportunities and peer support that come with working across practice boundaries.

The report also found that staff valued contact with senior leaders through training sessions and day-to-day contact, which helped to build trust and engage staff in service changes.

Dr Maureen Baker, chair of the Royal College of General Practitioners (RCGP), said: “Our population is growing and ageing and as a result patients are living longer, often with multiple, chronic conditions.


“GPs and our teams are seeing more patients then ever before and developing new methods of working, including large-scale GP organisations, such as federations of practices, is one way to help ensure that general practice can cope with this growing demand.

“This report – using data that the College has worked with the Nuffield Trust to collect and analyse – shows that large-scale general practice has a number of benefits, for both patients and staff.

“In particular, it highlights how working at scale can help sustain GP services, innovate in the best interests of patients, and enable GPs to develop leadership skills.”

The report however, emphasised the need for the Government and NHS England to manage their expectations “of what large-scale primary care organisations can achieve”.

Rebecca Rosen, a Nuffield Trust senior fellow and GP said: “Most English GPs are now joining large organisations, and this research shows how that can help to keep practices going after years of financial pressure and rising workload.

“What they need now is time and support to develop good relationships with other parts of the NHS, and to make the investments needed to realise long-term benefits.

“It is important that political and NHS leaders don’t let expectations of these new organisations run away from the reality.

“These are early days, but so far we see no sign that larger organisations are leading to better standards of care. Taking on new services is a major task and will take time.

“These groups will have to develop much further before they can take on the very complicated task of managing change across the health service.”

The Nuffield Trust received responses from 94 CCGs (45% of all CCGs) and from 982 GPs and practice representatives, from 184 CCGs, representing 87% of all CCGs, who identified their affiliations with about 210 large-scale collaborations.

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