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GP practices must merge to survive, GP leaders warn

GPs will have to merge, federate or form ‘super practices’ to survive in the new NHS, GP leaders have warned.

Debating the topic at the Pulse Live conference in Birmingham today, a group of GP leaders agreed that the traditional ‘cottage industry’ model of general practice was not fit for the future and that practices will have to evolve or face closure.

They said that new NHS landscape of competition, care integration and quality standards meant that economies of scale were needed for GP practices to survive.

Birmingham LMC executive secretary Dr Bob Morley argued GPs should learn from the legal and accountancy industries and merge together to keep their competitive edge.

He said: ‘For the traditional cottage industry to survive [we have to] look outside general practice, look at what has happened to firms of lawyers and accountants. How have they managed to maintain their businesses in a competitive environment: quite simply by merging. And that is what we felt had to do in our practice.

‘Change is inevitable and change is happening faster and faster in general practice. We have to understand that to keep what we value we have to look in a radically different direction. We have to think big. We need to have larger different models to survive, compete and prosper. If we want to keep what we’ve got then we must change.’

Dr Penny Newman, a GP and consultant in public health in NHS Midlands and East, warned GPs that they needs to create the ‘headspace’ to plan for the future of their practice, arguing in favour of practice federations and sessional GPs coming together to form ‘locum chambers’.

She said: ‘We work 12-hour days and we are also overwhelmed with admin, QOF and long term conditions and we are just trying to carry on, and very few have long-term plans for their practice.’

She added: ‘Is the cottage industry model fit for the future? No, because care is too complex. Can traditional partnerships survive? I don’t know. How can they adapt? GPs need to get some headspace to think about this. Get curious and speak to people.’

Nigel Edwards, senior fellow at the King’s Fund, argued in favour of ‘super practices’ that could hire their own specialists, for example in geriatrics, and have their own diagnostic hub to reduce referral barriers.

He said: ‘The challenge is to have the best of both worlds. I want the best I want the best of high-touch relationship-based primary care that general practice has done so well. I want high quality access to practices when I need it, and I want access to specialists as well. How might we do this? The answer that seems to be emerging is to try and get larger groups and networks to bring generalists together and bring together into a big enough scale.’

‘When we have got the scale we can hand over all of the management of domicillary care and social care to the practices.’

Readers' comments (11)

  • How can we fund specialists in primary care ? Is this funded from the tiny capitation fee or are we talking about CCGs funding this ?

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  • Not sure how you could square the diagnostic hub with having to offer choice!

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  • blah blah blah blah..blah..............................blah

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  • Its a nice idea but if practices are in debt and or are in negative equity then who will merge with them? There are a lots of boxes that need to be ticked before we can go down that road. A road which is still much less travelled at present. Therefore we must look at how other professions survived like suggested in this article.

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  • Why are we doing this? General Practice has always been the most efficient part of the health service and with QOF and chronic disease management on the whole we have seen standards rise hugely in our speciality. Why does it work? Because of our size and hands-on management at very grass-roots level. Do NOT destroy it chasing some far-fetched model which is currently trendy with our masters.

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  • This is just offensive clap trap from "leaders" who are out of touch and gone to too many conferences talking to other ner do wells who have time on their hands to pontificate about their basic human functions - last generation of "visionnaries" went on about same stuff 15 years ago - and when did the big scary monster turn up - daft scare mongering - at end of day big practices are the end of general practice - once we all become ladyboy GPs in our chambers dishing out supermarket style couldn't "care" will be the time the supermarkets, Virgin or any qualified nit wit will take over using nurses. So no - ignore our "leaders" - improve and develop traditional General Practice model of personal patient centred care for our patients - once your patients are the practice's or the federations - or worse your employers - personalised care will always see off the scary monsters and super creeps - that like the song are only bags of hot air that will go poof in the night.

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  • still cannot believe that GPs feel that single practices will survive. Well you lot will be left behind and in this new environment, when you will be competing against big providers such as Virgin/Care Uk/local trusts you will not have a chance on your own. In my area, leg ulcer management will be put out as AQP and to qualify for it, you will need to have your own specialist nurse. How will one practice on its own afford to get a specialist nurse in this domain? This is just one basic service. Other LES and DES will be put out as AQP and we will be earning less and less from them. If you do provide the AQP service, you will lose your rent money as the AQP work will not be qualified as GMS/PMS services. As you can see it will be lose lose situation on your own.

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  • @Anonymous | 01 May 2013 11:14pm

    As doctors our value is really in providing the fundamental core service of managing our patient's medical problems.That's what we're trained for.Anything else is superfluous and can quite easily be done by other parties.

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  • We don't get paid for leg ulcers in City centre practice's other than a hint of payment as regards the "basket of proceedures" couple of hundred pounds a quarter - so quite frankly - the commissioners can pay the money they don't pay us to give it to the private sector - yes please. Scare mongering that the sky is going to fall on our heads - is just that - by offering high quality personalised services is the way to win - and yes you've guessed it I'm single handed - by being tiny with a huge list we can be much more efficient than large/huge practices - why because being small you can remain focused without meetings with managers (we don't have any - individual members of team are their own bosses and responsible for overseeing their own tasks - being accountable to yourself and in turn rest of team gives individuals pride in jobs and desire to perform well) eg childhood immunisations we often get 100% - in 15 yrs never dipped below 90% despite "challanging patient mix" single parents - children at risk - screening - eg chlamydia on 15-24 yr old's we are highest performing practice in Hampshire - just short of 50% youngsters screened last year for chlamydia - and I could go on - Big practice's - I've worked in 2 large ones before - no time for clinical work to much "joined up working" and moving forwards and twaddle like that. Only thing we aren't allowed to do is dispense drugs - why BMA doesn't fight for city centre GPs like me to be able to dispense to my patients and get a nice take of the pharmacists profits bugs me no end - they want to move into my turf with they medical check-ups - good luck to them - but why can't I get a slice of dispensing income that the rural GPs enjoy? If big practice supermarket style clinics and the private sector can out perform small practices like my own then you are right its time to call it a day - but given their size how would they ever manage. Commissioners paying others to do work they don't pay us already for - bit like the out of hours thing in 2002/03 when we were told GPs doing their own thing was unacceptable and that only big organisations could run "quality" services - bit of walt Disney that? Heard it all before

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  • At least we don't have fights with our partners every Christmas over holidays !

    Single hander

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