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Independents' Day

Joining a super-practice provides shelter from the current storm

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With the news that an ‘alternative contract’ will be offered to GP practices from April 2017 comes the clearest indication yet that NHS England and the Department of Health want GP practices to work more closely together, more specifically with groups of patients in excess of 30,000. Although the details of the alternative contract are not yet known, there is an assumption that it will be more rewarding both financially and from the point of view of what I call the ‘bureaucracy-clinical work balance’.

The ways that GPs can put themselves in a position to apply (or bid?) for the alternative contract include forming federations and super-partnerships. One would assume that these structures will need to be in place and functioning well before taking on the alternative contract in 18 months.

 A colleague described being a GP partner like being on a small fishing boat in a very stormy ocean

Our practice has recently paid into and signed up to what looks to become the largest super-partnership in the UK - Our Health Partnership. As with other local practices the decision to join or not hasn’t been easy. An organisation that doesn’t actually formally exist, that is being created through the sweat and labour of a few committed GPs and colleagues, cannot offer any certainty about the future. There are risks and opportunities in abundance.

About 12 months ago a colleague described being a GP partner like being on a small fishing boat in a very stormy ocean. All hands are on deck and the direction of general practice is very much determined by elements beyond our control. We can only hope to ride the waves and use our experience to ensure that we don’t get sunk or shipwrecked.

Our Health Partnership doesn’t change the fact that the storm around general practice, and the wider NHS, hasn’t abated in the last year. If anything the waves are higher, the winds stronger, the currents deeper and the rocks more jagged. What it provides is a larger ship. It offers shelter for those weather-beaten, drenched workers who need some time below decks. It provides the opportunity for those elected to steer the ship from the bridge, taking into account the needs and desire of all on board.

There are ambitious hopes that size will provide the opportunity for savings due to the ability to negotiate for, among many other things, better indemnity deals, property maintenance contracts as well as enhanced services across the city. Being part of a larger organisation inevitably means the loss of the ability to steer one’s own course. Though I would argue that being tossed about on the wild seas of general practice in a small boat that the amount of autonomy and independence one had was an illusion. For now it feels as though we can steer our way to calmer waters.

Dr Samir Dawlatly is a GP in Birmingham

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Readers' comments (7)

  • Vinci Ho

    As I always say, it is all about survival, protection and defence as one of the three fronts of this war against the government . Advantages and disadvantages. The final decision was not taken lightly and hence, is to be respected .
    Different models exist in these super-partnerships(or federation), I suppose . It is good to have somebody inside the business to talk about the insights and more interestingly, how to retain identity and individuality as far as your patients are concerned . Ultimately , is 'alternative' contract really going to save you financially?

    It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to heaven......

    Charles Dickens

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  • PULSE offers a stream of the similar, all full of vision and hope, but hardly any details on what really matters, namely CONTRACTS.
    Are they PMS, GMS or draw up individual contracts with NHSE?
    Do they include other primary care organisations like pharmacists and optometrists?
    Do they have separate budgets, over and above the national average?
    Do they offer BMA contracts to their sessional doctors, or have they introduced their own?
    These questions have been asked before, but it seems that no one is prepared to answer them. I wonder why.

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  • I am afraid that Dr Dawlatly does not provide any reasonable business like argument for his decision to join Our Health Partnership. In his last para he mentions about opportunity for savings. These savings can be achieved by a simple SLA through co-operative style organisation with membership without giving up current contracts and individual autonomy. There are no financial figures published by such proposals that the savings achieved by this method will pay for the management and running costs of new Superpartnerships or Superpractices. Enhanced services currently form a small part of practice income and these services are available to the Practices through either national DES or local LISs. In the past many small practices like ours and our former group SBIC (19000 patients and 5 practices) have provided evidence of excellent management of practice based budgets during PBC, improved savings, improved clinical and financial performance and over £2.5 million of reinvestment in new models of care in partnership with local hospitals without the need for Superpractices. The real rational for creating Superpractices/partnership should be for getting new business (NHS and non-NHS), shifting many services such as OP from our outdated Hospital base and currently contracted from Community Health Trusts, bidding for Public Health Services and creating a new Integrated Care Organisation in the community with focus on Population Health. There are no wild seas and storms – most of this view has been created by media hype and institutional interests of few. To be able not only to survive but move forward in the current and future health care market place, one requires tenacity of purpose, resilience and strength. Much of the current focus is on GP profit and not clinical excellence.

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  • A super practice is just a legal structure of many practices joined together.Nothing changes at ground level.

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  • I ran a small grouping. OK and some economies and protected small practices. But these HUGE large area practices are quite different. It must draw the attention of the Competition and Markets Authority, since it imposes a monopoly in an area. The success of General Practice as against hospitals has been because GPs were in slight competition and self employed so kept our costs down. This will be lost down the track. This will be a disaster for patient with nowhere else to go.

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  • I ran a small grouping. OK and some economies and it protected small practices. These HUGE practices are quite different. They must draw the attention of the Competition and Markets Authority, since they impose a monopoly in an area.

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  • Let common sense prevail

    GP Commissioning rule #1:
    Shift activity from secondary into primary care because it is so much cheaper to deliver it there.

    Why is it cheaper? Presumably because the overheads of a small business are so much better controlled than that of a large hospital or NHS Trust.

    So why are the government intent on delivering primary care from bigger organisations in bigger buildings etc? I suspect that the affordability of primary care will disappear and we will be happy for the work to take place in a hospital.

    We (the NHS) will also be bankrupt.

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