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GPs go forth

65,000-patient super-practice looks to expand across England

A West Midlands ’super-practice’ covering 65,000 patients is set to expand across England following a number of approaches from other practices.

The Modality Partnership, which currently spans 15 practices across Birmingham and Sandwell - including the Bellevue Medical Centre where Professor Steve Field, the chief inspector of general practice, is a partner - has been approached by practices in London among other areas interested in joining the organisation.

Its executive director told Pulse the last 12 months had seen an increasing number of approaches from practices around the UK, both as part of established federations and individual practices.

The practices have expressed an interest in replicating the Modality model across the country as part of the same partnership, which would centralise back-office functions in a bid to increase efficiency and sustainability.

As part of the potential arrangements, the practices elsewhere would continue to tailor their service to their local population and commissioning arrangements.

The GPC favours super-practices as one of the few models which could retain the ‘core principles of general practice’ and working at scale is one of the principles set out in NHS England’s, Five Year Forward View.

Modality executive director Dr Naresh Rati told Pulse: ‘Over the last 12 months, we’ve been approached by a number of organisations suggesting “maybe we can scale-up jointly, and scale and replicate the [Modality] model in different parts of the country”.’

‘We’ve been established seven or eight years now, and for want of a better word we’ve done the back-office stuff… there’s an opportunity for us to scale that up quickly for patients’ benefit.

‘Patients in London, for example, will still see the front door entrance to their GP practice that they’re familiar with. But in the back end, we’ll be able to quickly centralise operations – which some practices are struggling with.’

What is a super-practice?

Super practice 580x837px

Super practice 580x837px

The Midlands have given rise to several super-practice ventures in the last 12 months.

These include 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, which Pulse first revealed in August.

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 (29)

  • Please stop calling them "super" - they are not. Super-sized, perhaps.

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  • These people
    are "businessman"....Money,money,money...

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  • Nice money spinner for the senior partners. I wonder how the patients feel about the level of care provided.

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  • What do the partners earn? I'd love to know if it is more or less than equivalent GP's.

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  • I work for Modality Partnership. The large size is helpful as there are many gpwsi to ask for advice if needed without needing to refer. There are economies of scale which makes the business more robust and allows extra services to be provided. The patient feedback is inline with other practices. Let's face it, they're interested in how quickly they can get an appointment rather than the practice organisation. Of course it's run as a business. @6:36, do you run your practice as a business or a charity?

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  • @10:33

    how are your experiences working for this organisation??

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  • @11:28

    In addition to my comment at 10:33, very positive. From my experience of working for several employers over the years as a salaried GP , I've found the larger practices better run and more supportive.

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  • Whats continuity of care like ?

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  • Patient feedback on NHS choices is dreadful!

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  • As long as patients have a choice between the super-practice and a small scale operator with it's perks and benefits, - I have no problem with it.

    As long as my practice is not made to provide a similar range of services and is able to refer our patients for treatment, - we would not even mind if they were sent to Modality or whatever.

    We would not even mind if they nicked our patients, as long as patient's choice of practice is protected.

    In fact, I would welcome them into our area and team up in resisting CCG-driven mergers, accountable care organisations, etc as membership in those is supposed to be entirely voluntary.

    As long as we are not pressured and left alone to run our GMS contract, we will be effective and efficient and make good money for the partners in the process.

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  • The dying embers of the “core principles of general practice”. Now run for the benefit of the last small group of senior elected or appointed partners. When they retire – that’s it.

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  • It's a complete myth that larger practices are run for the benefit of the partners whereas smaller practices are run more holistically. In the modern age we are competing for patients who act as customers and are free to move their registration elsewhere. The worst example I have come across was a single partnered father to son practice which showed pennypinching and work avoidance on a biblical scale !

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  • |Anonymous | Salaried GP|09 Feb 2016 11:07am

    It's a complete myth that we are competing for patients.

    The evidence can be found in the number of list closure applications.

    The reality is that practices are competing for good GPs with money and working conditions.

    Good practices can recruit salaried GPs and partners while struggling practices... erm... struggle.

    Last time we advertised for a Salaried GP, we had a queue of candidates, despite the fact that we are a 4k captiation GMS with no bells and whistles.

    Neighbouring practices, small and large have recruitment issues because some of them have partners who noone wants to work for or APMS practices that want to squeeze water out of a stone.

    Division by good/bad according to size is inappropriate.

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  • Practice manager @12:30

    Through your comment you have confirmed that my statement that division of practices as either good or bad according to their size is wrong. What really matters is the quality of the staff and the quality of the service delivered.

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  • Salaried GP 11:07 am

    I didn't feel (and after re-reading it still don't) that your previous comment contained that statement, particularly in the context of this discussion.

    But since you have clarified your position I can only conclude that we are definitely in agreement.

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  • The future of 'Family Mecicine'. What a shame.

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  • Looks like anonymous is the trend

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  • @1:53 medical student.

    Learn how to spell, then gain real world working experience, then comment.

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  • Vinci Ho

    Remember the name of this song , Mr Stevens?:-

    Some of them want to use you
    Some of them want to get used by you
    Some of them want to abuse you
    Some of them want to be abused........

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  • @2:07pm salaried.

    If your so wise then why are you still a salaried slave? Locum, migrate or retire!

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  • @3:39 medical student

    Firstly it's you're not your. Secondly, I have a good mix of salaried and locum work. I have no wish to be a partner, migrate or retire.

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  • This comment has been removed by the moderator.

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  • @3:48 medical student

    But I enjoy my salaried work so I don't feel like a slave. Also I'm paid well for it and have freedom of choice so can't by definition be a slave. Since you've never worked as a doctor, I suggest you comment later, a few years from now.

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  • Word of advice my dear salaried friend: don't respond to trolls.

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  • In a few years from now you will be chasing up the results of investigations I order in secondary care. X

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  • |Anonymous | Medical student|09 Feb 2016 4:09pm

    "In a few years from now you will be chasing up the results of investigations I order in secondary care. X"

    Only for as long as it takes for the GMC to investigate your conduct.

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  • Note to the not so smart medical student:

    Good medical practice, section on Continuity and coordination of care. Expanded in Delegation and referral
    (2013) explanatory guidance. In particular, paragraph 2

    Please familiarise yourself with this before one of your patients picks up the price of your ignorance.

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  • Dear practice manager.

    That's exactly the point I'm making! You didn't hesitate for a moment in reminding me about good medical practice but how many consultants have you actually forwarded this message to? I bet none. No point in reminding medical students on good medical practice when in real working life you're getting inappropriate hospital requests all the time yet you're doing nothing about it. Sounds like you're just venting your frustrations on someone powerless. This is the state of general practice.

    My message isn't specifically directed towards you but to general practice in general...

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  • Dear Medical Student,

    My practice ( and many neighbouring others) has a template letter as advised by BMA, that gets printed out by medical secretary who has been trained to identify such inappropriate request.

    That template letter is then stapled to any suspect piece of correspondence that lands in the GP in-tray and they then take a decision on whether to sign and stamp it before sending it back.

    If the GP is pinging back the request to the consultant (2-3 a week at the moment, the volume came down of late, used to be 20-30 a week), our reception then attaches trust's medical director message to his clinicians reminding him of the same.

    And then the medical director gets mocked at GP engaging meetings for failing to control his team.

    Great fun all round.

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