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NHS England primary care lead to form 44,000 patient super-practice



NHS England’s primary care commissioning lead is set to merge his small York practice with other local surgeries to form a new 44,000 patient super-practice.

Dr David Geddes, speaking at a Westminster Health Forum event yesterday, told Pulse that the shift would allow them to employ a range of other health professionals to improve care for patients with multiple morbidities, including a paramedic.

At the same event GPC chair Dr Chaand Nagpaul said there were now more than 50 practices in England with more than 30,000 patients.

Last year Pulse explored the rise of the super-practice, including two behemoth Midlands ventures: 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. 

In the event on new care models and the future of primary care in London, Dr Geddes said that there was going to be an increase in super-practices.

Dr Geddes said: ‘Absolutely primary care will change its model, but change isn’t an end to itself but to develop a more effective integrated care pathway for patients.

‘So federations is one solution, there will be networks. There are certainly a number of super-practices, or bigger practices developing and merging together to become 30,000 or 40,000 [patient practices].’

‘My own practice, which is currently 5,200 [patients] merges later this year to become 44,000 but that in itself, is not the answer.’

Dr Geddes told Pulse that workforce crisis affecting large parts of UK general practice were beginning to be felt in York. And he hoped the move to working at scale change would allow them to bring in other professionals to manage workload and offer combined appointments for complex patients.

He said: ‘‘We’re getting a paramedic, that’s a bit of an experiment we don’t really know how it’ll work but they’ll do visits and things like that.

‘There is a risk of duplication, but that’s about having the information, ensuring notes are well written so it can be picked up.

‘We need to do better – and this is a change – that I can take up where the nurse has left off. So we’re working in a more joined up fashion, and for the patients that conversation is picked up.’

GPC chair Dr Chaand Nagpaul presented a slide showing there were more then 50 practices with 30,000 patients in England now.

He told delegates that working at scale can provide a buffer to support practices including managing workload and enabling a practice group to employ a broader range of professions.

He added: ‘This is happening already, we know that none of these ideas are new but it’s happening haphazardly, and it’s happening on the ground as we speak. Whether it’s creating super-partnerships, federations, Devo-Man and others, MCPs and PACs, trusts entering into arrangements with GP practices. There is a bottom up and a national approach to working at scale.’

What is a super-practice?

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’.