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At the heart of general practice since 1960

NHS England primary care lead to form 44,000 patient super-practice

NHS England’s primary care commissioning lead is set to merge his small York practice with other local surgeries to form a new 44,000 patient super-practice.

Dr David Geddes, speaking at a Westminster Health Forum event yesterday, told Pulse that the shift would allow them to employ a range of other health professionals to improve care for patients with multiple morbidities, including a paramedic.

At the same event GPC chair Dr Chaand Nagpaul said there were now more than 50 practices in England with more than 30,000 patients.

Last year Pulse explored the rise of the super-practice, including two behemoth Midlands ventures: the 100,000 patient, 62 partner practice at Lakeside Healthcare, East Midlands and the gigantic Our Health Partnership in Birmingham and Sutton Coldfield, which involves 200 GP partners and a list of 275,000 patients. 

In the event on new care models and the future of primary care in London, Dr Geddes said that there was going to be an increase in super-practices.

Dr Geddes said: ‘Absolutely primary care will change its model, but change isn’t an end to itself but to develop a more effective integrated care pathway for patients.

‘So federations is one solution, there will be networks. There are certainly a number of super-practices, or bigger practices developing and merging together to become 30,000 or 40,000 [patient practices].’

‘My own practice, which is currently 5,200 [patients] merges later this year to become 44,000 but that in itself, is not the answer.’

Dr Geddes told Pulse that workforce crisis affecting large parts of UK general practice were beginning to be felt in York. And he hoped the move to working at scale change would allow them to bring in other professionals to manage workload and offer combined appointments for complex patients.

He said: ‘‘We’re getting a paramedic, that’s a bit of an experiment we don’t really know how it’ll work but they’ll do visits and things like that.

‘There is a risk of duplication, but that’s about having the information, ensuring notes are well written so it can be picked up.

‘We need to do better – and this is a change – that I can take up where the nurse has left off. So we’re working in a more joined up fashion, and for the patients that conversation is picked up.’

GPC chair Dr Chaand Nagpaul presented a slide showing there were more then 50 practices with 30,000 patients in England now.

He told delegates that working at scale can provide a buffer to support practices including managing workload and enabling a practice group to employ a broader range of professions.

He added: ‘This is happening already, we know that none of these ideas are new but it’s happening haphazardly, and it’s happening on the ground as we speak. Whether it’s creating super-partnerships, federations, Devo-Man and others, MCPs and PACs, trusts entering into arrangements with GP practices. There is a bottom up and a national approach to working at scale.’

What is a super-practice?

Often formed by a series of list mergers, super-practices are typically run by a small group of elected or appointed partners.

The GPC defines it as one GP practice covering a very large patient population, potentially in excess of 100,000, and which operates from a number of sites despite being a single organisation.

The GPC said in its vision for the future that super-practices could be one of the few ways of ensuring the ‘core principles’ of general practice are retained, with GP list sizes growing by 28% since 2002.

And NHS England is keen for these larger GP organisations to take on new functions. NHS England chief executive Simon Stevens said accountable care organisations are the future, saying it was ‘mission-critical’ to ‘blur the old boundaries between GP and hospital care’.

Readers' comments (33)

  • "What is a super-practice?
    The GPC defines it as one GP practice covering a very large patient population, potentially in excess of 100,000, and which operates from a number of sites despite being a single organisation."

    Does it have to be on a number of sites? Surely the most efficient way is to eventually do away with crappy old sites, then make it 1 purpose built site.
    One of the massive upsides is having the resources to have other professionals involved. But you cannot have a physio gym or opthamology suite at every site - but you could if there was just one site.

    A massive super-practice can then take on other services in their single site ---- Like minor injuries, minor surgery and diagnostic procedures. Over time, as staff numbers and skills develop, they can broader the range of what they do and the specialism of their departments - for example bigger emergencies rather than minor injuries.

    One day they might decide that the term super-practice is not really fit for purpose.
    They can then employ a management consultant lots of money to think of a better term.

    After great thought and expense, the management consultant will tell them that what they have got.......

    Is a HOSPITAL.

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  • Essentially we will all be working in cottage hospitals termed super practices as under paid consultants doing the work which they don't want to do. And the RCGP calls this an exciting change

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  • Vinci Ho

    So there is no ceiling of this merging ?
    Eventually , all practices cutrently in one CCG are all merged into one super-practice .
    One CCG, one practice ???

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  • And the patient might see the same doctor once out of 50 consultations .

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  • Isnt there a conflict of interests here?I know we could merge all gp practices/hospitals and health centres together and make one big practice, we could call it the NHS!

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  • ‘We’re getting a paramedic, that’s a bit of an experiment we don’t really know how it’ll work but they’ll do visits and things like that'.
    How about Dr Geddes you and your chums make general practice more enticing for doctors than experimenting with paramedics.

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  • John Glasspool

    I wonder if he is related to Joe90? I think we should be told

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  • Nothing like determining the future of entire general practice from your two sessions a week in real general practice

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  • nobody cares but patients hate super practices

    look at the comments on NHS choices

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  • Large does not equal super !

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