Many GPs are wondering how to survive a future consisting of rising demand, revalidation, falling practice income, clinical commissioning group (CCG) scrutiny and more. Smaller practices in particular, with few staff, minimal infrastructure and tight budgets are struggling with the greater organisational, administrative and clinical demands.
Inevitably the question about how to increase the scale, resilience and quality of general practice comes up with increasing frequency. New Zealand, America and Holland all present examples of GPs grouping together to retain more control over working arrangements and exert greater influence on their patients’ wider use of health care services.
At a recent Nuffield Trust seminar delegates seized on the chance to take a forensic look at another such initiative, this time based in the Midlands. The Vitality Partnership was formed in 2009 through a merger of two practices. Three years later, seven practices now operate under an overarching partnership agreement with a total list size of 51,000, approximately £10m turnover and over 150 staff.
In addition to general and primary medical services (GMS and PMS) Vitality currently offers nine specialist services through a combination of GPs with special interests and outreach consultants. More are planned, along with wider primary care (dentistry, pharmacy and community nursing).
With a potential referral base of 80,000 the business case for investing in equipment and services looks strong – albeit within a policy context that promotes choice and competition.
The context of current reform presents challenges – with clinical commissioners having to manage potential conflicts of interest associated with buying services from Vitality while ensuring that choice is not compromised for example.
As a pragmatic alternative to merging NHS contracts the partnership holds multiple GMS and PMS contracts but there is also one overarching partnership agreement in place. This defines standards in relation to quality, access and other areas of practice, that incoming partners sign up to when joining.
In return for the intensive peer review that this implies members benefit from the financial stability associated with a larger organisation. For younger GPs – including those who are currently salaried – there is a career structure ranging from associate-partnership without any managerial responsibility through to managing partners with extensive management roles.
Once signed up to the over-arching partnership a doctor can choose to leave but their patients stay with Vitality as with a traditional arrangement.
Joining therefore, entails a mixture of courtship and due dilligence. Scrutiny of performance and finances runs alongside assessment of ethos. Mergers have stalled due to insurmountable differences in both the finances of potential partners and their personal goals and values. The due diligence of course works both ways.
It has not been an easy ride for Vitality – whose senior staff have invested immense energy and commitment. They describe themselves as being on a long journey, but they have a clear sense of where they want to go. Certainly what is emerging is an organisation that feels relatively confident about the future.
Some of the key themes identified in previous reports into organised general practice here and abroad resonate with the emerging story of Vitality: strong organisational values focused on peer-review and improvement; a desire to remain in control of the services they deliver and to withstand the influence of changing national policy and clinicians who want to leading change and innovation.
This blog was also published on GPonline.com