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Independents' Day

Practice profile: England's largest practice

Partner Dr Richard Thompson explains how his 50,000-patient practice uses its size to win contracts, maintain continuity of care and ensure its GPs have fulfilling careers

Name Priory Medical Group, York

List size Around 53,000

Full-time equivalent GPs 40 (16 partners)

Surgeries Nine

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Our size is a major strength

We have more than 50,000 patients so we are in a strong position to negotiate with the CCG and local area team. If they get us on board, we can help them reach a higher proportion of their target number of patients. That said, we’re part of an informal federation, covering about 100,000 patients – we consider this the minimum to win bigger contracts.

Our main challenge is communication

It’s hard to get everyone doing the same thing, as the team is so big. We don’t have whole-team meetings very often because they wouldn’t work, so we have monthly management reports, then monthly partners’ meetings. Then partners take the messages back to each branch. Each salaried GP has a partner in a ‘line manager’-type role.

Every GP has a ‘portfolio’ career

All 16 partners have very varied roles: training registrars or foundation-year doctors; providing care under our contracts with two prisons and a local school; or running research projects.

Partners do very little business work

The practice is run by a management group made of two GP managing partners, a business partner and managers for IT and human resources. Our practice manager used to be a vice-president for an investment bank – we had to advertise nationally to find him. Our HR manager has NHS experience and previously worked in a food packaging business.

We have never had to wait to fill a vacancy

We have four or five trainees and some foundation-year doctors, and we prefer to employ new salaried GPs from that pool. Our progress scheme then invites salaried GPs to take on business work if they are interested in being a partner. We review their performance quarterly, and if they do well, we make them associate partners, with a bonus to their income and more responsibility. We also plan the partner workforce two to three years in advance so that we can anticipate vacancies.

We use locums more than we would like

We try to predict what we’ll need in six to nine months’ time, but sometimes we need locums to plug gaps. We had a period when it was hard to find salaried GPs, so we recruited nurse practitioners. The drought is over, but now we have covered ourselves to cope with urgent care demands.

We want patients to receive a ‘family doctor’ service

Although we don’t have personal lists, patients appreciate the continuity of care that we offer – we never shuffle them between branches. All our GPs work at a specific site.

Receptionists do not take phone calls

Each of the nine surgeries employs two receptionists. They take turns welcoming patients and dealing with queries, and helping GPs with clinical work. All phone calls are taken in the main office and we monitor how many calls we’ve missed and the average wait time, so we can take action to keep both numbers low.

Our QOF performance was 99.2% last year

We have an associate partner managing our QOF activity and we aim for 100%. Performance is reviewed fortnightly and we have a quick response to failing indicators. If we are falling behind with epilepsy reviews, for instance, we launch a phone campaign and get nurses in for an evening surgery to run a clinic. We design IT templates and try to put as much information in them as possible so GPs don’t need to hunt for the latest guidelines. We update them when guidance changes. 

Readers' comments (12)

  • Sounds Horrendous

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  • why? This is how a business is run.Clear vision is key.

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  • An impressive set up.
    There will always be pros and cons to any practice size, and often quite bitterly held strong views as to what is best, but this practice is clearly more able to withstand the continued primary care squeeze than most.

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  • Sounds like the future.

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  • Lol @ progress scheme... why would anyone wanna be a partner these days??

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  • Russell Thorpe

    "we monitor how many calls weve missed" As in none in 25 yrs at my practice. Battery farm GP's not conducive to job satisfaction and performance. All of this may well open the door to private GP practice. People want to know who their GP is and be able to see them, with the prescription charge at £8 I can envisage many will be willing to pay for a traditional primary care service. I might get that Bentley yet!

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  • Too big, patients really miss the smaller 'family GP' practices.

    A manager I know is pretty useless, spends too much time getting involved with issues outside his expertise, so much so that his own work never gets done. Arrogant, fat and lazy are the words that come to mind!

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  • Russell Thorpe: "All of this may well open the door to private GP practice"
    It is a private practice - the Priory group have a York monopoly (through 'mergers' which led to GP resignations) and they advertise a cosmetic skin surgery on their website at which work some of the GPs who are in the 'NHS' surgeries.
    How much more privatised can you get?

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  • I've never been in favour of the trend to get larger and larger, and those 'empire builders' that I have been acquainted with are often not very nice people. They are happy to show off their palatial surgeries but seem quite oblivious to the patients constantly grumbling about poor service, impersonal care, no appointments etc.
    I am in a small practice (5000) and I am not convinced that we should rush into federations. This feels like a buzz word that has been put forward as 'the next big thing' but I'm not convinced that we have seen this model work for us or our patients yet.
    There is enormous value in being small, dynamic and patient-friendly, and we should not throw that out with the bathwater.

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  • Dark Satanic Mills !

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