A new Nuffield Trust report shows 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. It finds these organisations can help to sustain general practice in the face of intense financial pressure and shortages of doctors and nurses. However, they have so far made limited progress in expanding into new services, and taking on a strategic role in redesigning care. The authors urge policymakers and practitioners to be realistic in their expectations.
‘Is Bigger Better? Lessons for large scale general practice’ is based on national surveys and in-depth case studies of four organisations, which are limited companies or partnerships containing a total of 150 practices. It finds that they have stabilised GP services by pooling resources, standardising ways of working, and bringing in more income – which is often reinvested. Collaborating to share and develop staff has also helped tackle shortages, and improved satisfaction among most professional groups.
Analysis across the case study sites and similar organisations found that so far they had performed no better than average on the national framework of indicators for quality and outcomes of care. Most did better than average at prescribing drugs in line with best practice. But they failed to buck downward national trends on other indicators of care quality, including patient satisfaction. The case studies found that while some patients were enthusiastic about opportunities to access their GP in new ways, others were worried they would lose contact with their usual GP and find it hard to use their local surgery.
NHS England’s Forward View anticipates that large scale GP organisations will expand to manage services like district nursing, and take on specialist care and staff. The study found initiatives underway to achieve this, but only at a small scale. Only one of the case study sites was trying to tackle larger scale service changes. The authors warn that there is a danger of expectations of these organisations running ahead of what can be delivered. However, they are relatively new and future developments may be more substantial.
The research finds that trust and close engagement with commissioners and specialists are very important if new GP organisations are to take on services successfully. Conflicts of interest can be an issue because GPs sit on the clinical commissioning groups that award contracts. They must be carefully managed.
Nuffield Trust Senior Fellow and GP Rebecca Rosen 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.”
Notes to editors
- Is Bigger Better? Lessons for large scale general practice is authored by Rebecca Rosen, Stephanie Kumpunen, Natasha Curry, Alisha Davies, Luisa Pettigrew and Lucia Kossarova. A summary for policymakers and commissioners is attached. A full report giving detailed lessons for GPs, will be available on our website.
- The report uses two national surveys, carried out with the Royal College of General Practitioners, to determine the extent of GPs working in scaled up organisations. Researchers also tracked four case study organisations in depth, observing meetings, interviewing key figures and reviewing documents. A quantitative analysis of trends and achievement in quality was carried out for eight organisations.