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Superpractices looking to take leadership roles on GP networks across England

Two superpractices are offering to take on leadership roles in a number of primary care networks, including providing back-office support and being a 'custodian of funds' for the new networks.

Modality Partnership, a super partnership based in Birmingham, wants to lead primary care networks across the country, its chief executive told HSJ.

Pulse has also learned that Our Health Partnership (OHP), the UK's largest super-partnership has also offered to act as governance for networks. 

Under the new GP contract, practices have to join networks of 30,000-50,000 patients in order to access huge chunks of funding. 

The networks can be structured in various ways - including all practices having equal rights, or one practice providing all the leadership - but in all cases, a network will have to appoint a practice to receive all the funding.

'Superpractices' - which are practices covering hundreds of thousands of patients, and will often have sites in various parts of the country - will not be able to form a single network, the contract has stipulated.

It has emerged that two of these superpractices want to lead networks across the country that will incorporate practices outside their networks.

OHP chair Dr Vish Ratnasuriya told Pulse: 'Our Health Partnership’s offer for PCNs was developed by our 200 GP partners and existing network leads across Birmingham and Shropshire. It builds on our existing culture of collaboration between practices working with the wider system.

'OHP’s central finance and governance team already support over 50 practices both within the partnership and those aligned for certain clinical services. OHP’s model of support, including the option of holding contracts centrally for PCNs, frees up local clinical leaders to focus on the development of their PCNs and bring together services for patients effectively. This will build the collaborative foundations we believe is needed to deliver the vision of the NHS long-term plan over the next five years.'

Modality chief executive Vincent Sai said that Modality practices will offer to act as the custodian of funds when joining a network. The superpractices has sites across England and has offered to lead developing networks in Walsall and mid-Sussex.

Mr Sai stated that 'We’re already doing it in Walsall.'

He continued: 'For the networks with the contracts, we’re leading, we are playing the custodian of those [network] funds.'

Modality has seven partners in the area and they were already leading on two networks due to having ‘larger practices in that footprint.’

Mr Sai told Pulse: 'We have two clinical directors within two PCN sites in Walsall, and Modality Partnership is represented across all Walsall PCNs.'

He told HSJ that they were also in five other Walsall network and ‘we have one [member] site in each’

He added: ‘What we are doing there is making sure the right leadership is in place for the network. And it doesn’t have to be a Modality partner to be the lead, it needs to make sense for the colleagues on the ground.’

Walsall medical secretary Dr Uzma Ahmad said: ’We have a pilot project running from the last few weeks and Modality are correct in that they are leading on the two described, but this is not a formal arrangement as of yet because the formal network hasn’t taken place.

'From an LMC point of view, we do welcome all models of general practice to take part in a network. We’re quite open about that. I think it’s a great opportunity for all sorts of models working at scale or Modality or non-Modality practices to work together.

‘The only issue would be to make sure the governance structure is done properly so any conflict of interest must be managed more strictly so there are no other practices at a disadvantage of being in a network with a larger group. This is the kind of work that is in progress at the moment.’

Modality also has said to be developing a network with three of its practice with another non-Modality practice in mid-Sussex.

Mr Sai did not confirm that networks have accepted Modality’s offer to be the leading payee and administrator, as networks are still not formalized as of yet.

A Modality spokesperson told Pulse, however: ‘In terms of leadership, we’re not saying we’re definitely doing it.'

‘We run 10 practices in Walsall and we are already leading and supporting informally across the PCNs there. We are able to offer the support that PCNs need and we want to work together to deliver this.’

The news comes as some practices are being forced by CCGs to form networks with practices who do not have a working relationship.

Meanwhile, NHS England has recently stated that networks do not have to be led by GPs and that with 'any clinician' in general practice able to take charge.

This article was corrected on 15/04 09:15 to reflect that Modality have since changed their quote from saying they run the majority of practices in Walsall, to reflect that they run ten. 

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Readers' comments (9)

  • Think of it as like an ‘Ant colony social structure’ but less fascinating!

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  • Can we refer difficult patients to the clinical director?

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  • National Hopeless Service


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  • Maggots feeding on the just alive but rotting carcass that is the NHS.

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  • agree with turn out the lights. the whole concept of PCNs is just another diversion away from the intrenched decline in proper General Practice. it will create yet another industry in "Managing" GP but nothing to restoring General Practice. All the funding for parapatetics will only create increased diversity and nothing for continuity of care or patient benefit.

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  • Agree, nothing I’ve seen so far looks at improving continuity which we know actually keeps patients away from secondary care. It’s just a vehicle for funding new staff in primary care that will work across networks. Cheaper alternatives toGPs which no one can get for love nor money.

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  • NHSE and the Govt have honed their skills to repeatedly do the same stupid things under different names - they called it Darzi Centres, now in our area they plan to 'build' a new Hub Centre from scratch and are coercing GP Surgeries to agree to move into these lest 'Virgin' takes over !! Already shiverrring with fright at the prospect, though we know who is going to get Contracts. It certainly won't be Virgin.
    GPs working in London for CCGs 2 days a week can get up to 70 k but the PCN Clinical leads are now expected to work for money that even does not provide for the backfill for the Surgery. Of course, we invite and rather challenge CCGs to talk Virgin into taking over. Private providers are not stupid but yes, people working in CCGs with ambitions to flog GPs are welcome to the role.

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  • Vinci Ho

    Is GP networking a Trojan Horse ?

    Desperate times need desperate measures.
    On the land of politics in our country, nothing is currently more controversial than the cross-party discussion of the direction Brexit will take place between Labour and Conservative parties .
    For our beloved GP land , the formation of GP networks is the main theme of this new five-year GP contract . The price tags have been allocated but we are yet to see the actual money as far as the bookkeepers of the networks are concerned.
    Finally , in the fantasy world of Westeros( Game of Thrones) , we saw the incest-bound union(more appropriately mating )between Daenerys Targaryen and Jon Snow , the relationship of whom we know now as aunt and nephew.
    All parties of interest in these three worlds have one thing in common : their fundamental relationship is potentially competitive and antagonistic with the risk of serving as anathema to each other .


    Like every new ideology appearing on the horizon, we should lay aside our prejudice for a minute and welcome it with open arms. But that , certainly, does not mean questions are not to be asked . My LMC Secretary once taught me, ‘ Do not ask the question in politics unless you knew the answers.’ So there are some questions worth considering for this notion of GP networking:
    (1) Can member practices in a network live happy ever after ?
    As I wrote before , it is difficult for five GP partners in a practice to agree unanimously on certain issues , how hard is it to be in a network covering 30-50,000 patients. Always remember the trilemma principle:- amongst sovereignty, integration and democracy, one can only have two out of the three but never all of them.
    (2) How can the new resources injected into GP networks from the governments be evenly and fairly distributed? For example, for pharmacists , physician assistants , physiotherapists , how much time should they spend in each member practice every week? And when it comes to the new money and how to spend it; well , the caveat is in fact , a potential civil war within a network?
    (3) Perhaps , that is why ‘super-practices’ come into the equation . They provide the governance to save your headaches and settle disputes with your fellow network members . Actually, this is an extraordinary phenomenon simply because the government refuses to equate super-practices with GP networks. Bottom line is , it wants to move away from investing in GP practices individually . Will this create another complex behemoth of bureaucracy stifling flexibility and hence , efficiency? What is the natural history of these big monsters eventually?
    (4) We need the new money to address this current crisis of shortage in resources. We have been starved of tools to provide the current services . The objectives of this new contract , however , appear to be , by GP networking , widening the ‘dumping ground ‘ for more work to be thrown at us from all directions. Yes , you are giving us some new tools but these are easily outweighed by the number of new tasks waiting on the line . Where is the STOP button ?
    5) Hence , last but not the least , GP workload . I am yet to be convinced that the government actually understood how heavy our daily workload was before it sat down to negotiate this new contract with our representatives. Because not too long ago , its propaganda media( you know who!) was still bashing and condemning us as lazy , ignorant and irresponsible ( the tone might have been changed after the Big Boss stepped down ) . If it was not for some strident figures showing a dramatic drop in the number of full-time equivalent GPs in the country ( all four nations) last few years , do you think we would have had this conversation today ? Crisis , what crisis? Remember that ?
    Having said that , I understand from listening to our BMA colleague during a recent roadshow that the new contract is subjected to some path-finding and self-correction as we move down the road . But this can only be credible if the government is receptive and shows some humility.
    Hence , I am looking forward to see Jaimie’s new born baby called GP workload survey report .
    Step by step
    Heart to heart
    Left, right, left
    We all fall down
    Like toy soldiers
    Bit by bit torn apart
    We never win
    But the battle wages on
    For toy soldiers

    Too many of our colleagues have been burnt out and fallen down . Is it my fantasy that all toy soldiers can , one day , unite together as a true army to resist our enemy who is always trying to divide and conquer us ?

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  • Grasping for the money! Which of these grasping 'supers' cares two hoots for a single patient?
    What is the opposite of so-called 'super'?
    Watch out you practices that are not super: the words 'swindling you' springs to mind, and'more
    hoops for you to spring through' to get your share...

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