GP collaboration and the push for primary care at scale

We will be publishing a series of articles on different ways GPs can collaborate and the different issues to consider when collaborating in the coming weeks. These will help you make informed decisions and get you thinking about the crucial points that will need to be cleared between you and your peers on the journey to a successful collaboration.

What has been happening?

The Five Year Forward View and Next Steps set out the ambitious plans of NHS England to deliver the national programme to drive up quality and efficiency of service provision and to improve patient benefit.

The focus has been on getting primary care to lead some of these programmes and to have GPs work together in collaborative structures to deliver not only primary care at scale but also to lead on the ‘care closer to home’ trajectory. In order for GPs to deliver good or outstanding care, they will increasingly need to work together in larger groups and no longer focus on ‘doing it’ on their own. The recruitment crisis is well known, with fewer GPs, the pressures especially for single-handed GP practices to stay afloat are more daunting than ever.

The GP Forward View sets out the national blueprint and the expectations for GPs and primary care providers in this regard. We have worked with GP practices as well as commissioners on this programme. Our GP clients have formed all manner of different models of collaboration from super-practices, federations, alliances and primary care homes to help them achieve this aim.

Some of the challenges can be mitigated by working together, including:

Challenge: increased funding pressure on primary care

Despite the financial promises in the GP Forward View, practices can still struggle to deliver the services required under their primary care contracts, along with extended access and other requirements of integration and primary care at scale required when participating in one of the new models of care structures. By uniting to work together, e.g. simply by sharing back room services, staff and outsourcing support services can really assist towards funds being better managed. Our clients have found that working together to deliver clinical services can also improve quality of care and choice for patients by the sharing of specialities and skills across a wider patient cohort.

Challenge: people living longer with long term conditions

People are living longer, often with long term health conditions. National programmes are being implemented to help practices support patients who are living with long term conditions to improve their self-care. Whilst this is in progress, GPs have to provide more appointments to be able to see their other patients. Additional nurses are being provided for example through the Better Care Fund, to assist patients with long term conditions, as well as implementing training in practices so patients can be taught how to self-care. These resources can be shared effectively between practices when working together. In addition, by working together, practices can jointly fund additional resource and nurse-led solutions to reduce GP appointments and free up GP time.

Challenge: pressures of a growing patient list

Recently the BMA balloted GPs on whether they would be willing to collectively close their patient lists, with an overwhelming amount of GPs voting in favour of either a temporary or permanent close to help them keep up with patient safety requirements. The pressures have been building for general practice for some time now, and the importance of practices working together in collaborations to help ease some of this pressure has never been more paramount.

Challenge: increase in GP indemnity costs

A major concern in general practice over the last few years has been the increase in costs of indemnity. Some GPs have made it clear that the rising costs will make it unsustainable for them to remain open, or be able to provide certain services, such as out of hours, which as a service is easier to provide when GPs work together. In attempt to address these concerns, a new GP indemnity short term financial support scheme was implemented by NHS England and the Department of Health in 2016/17 to provide a special payment to practices to offset average indemnity inflation, linked to unweighted patient population. More recently, Jeremy Hunt has announced the development of a state-backed indemnity scheme for GPs. When created, this scheme should help mitigate rising costs and enable GPs to be more open to the idea of collaborating and providing further services.

Challenge: increasing burden on single handed GP practices

The CQC have increased their focus on GP practices and are uncovering instances of poor care around the country which need to be rectified. This increases the administrative burden and cost of compliance on GPs, especially single handers. Strong leadership and a collaborative approach in dealing with (and responding to) the CQC may help to manage these issues more effectively.

A number of collaborative working models are emerging to help primary care deal with these challenges including:

Primary care home

The primary care home model developed by the National Association of Primary Care and piloted with NHS England, has been very successful in showing efficiencies and savings as well as developing different ways of working for primary care. The purpose of the model is to bring care to the local population and closer to the patient’s home. GPs work with multiple other providers (e.g. community, mental health, acute, social care) and the approach is similar to MCPs but on smaller scale of registered populations between 30,000 to 50,000 patients.

The main features for this model are creating an integrated work force, focusing on ‘partnerships’ between primary, secondary and social care, the personalisation of care as well as sharing risk and reward and aligning clinical and financial drivers. Some of our clients are working in PCHs and the GPs have needed to create collaborative structures to get the most out of this model.

Franchise federation

We will cover these in detail in our next article, but there are a number of models across the country where GPs are linked together as a ‘franchise’ or ‘super-partnership’.

NHS foundation trust supported primary care

In some areas of the country NHS trusts are partnering and joint venturing with GP federations to help meet these challenges together. For example in Northampton the mental health and community trust has a formal corporate joint venture arrangement with 3Sixty Care, an ‘at scale’ GP provider.