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Large-scale GP practice organisations help with demand but not quality of care


20 July 2016

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Large-scale GP organisations can offer extended services if they have positive, collaborative relationships with their local clinical commissioning group (CCG).

A Nuffield Trust report, Is Bigger Better? Lessons for large scale general practice, has found that nearly three quarters of practices have joined large-scale GP organisations to help them cope with rising demand.

Large-scale GP organisations can offer extended services if they have positive, collaborative relationships with their local clinical commissioning group (CCG).

A Nuffield Trust report, Is Bigger Better? Lessons for large scale general practice, has found that nearly three quarters of practices have joined large-scale GP organisations to help them cope with rising demand.

Many of these organisations have established high-quality specialist clinics on a small scale, however, practice groups said they found it easier to deliver these extended services if they had good working relationships with their CCG.

In most cases, practice groups found it easier to form relationships with their commissioner if all the practices in the group are in the same CCG.

Furthermore, relationships with CCGs were strengthened if the general practice organisation could help to achieve commissioning priorities.

However, where CCG staff perceived the general practice organisation as a profit-oriented private company, these relationships failed.

Generally, while there was no evidence to suggest any differences in quality of care compared to the national average, patient satisfaction was mixed.

The report found that some patients voiced concerns about losing the ongoing, trusted relationship with their GP.

Consequently, the report advised large GP organisations to “harness the benefits of larger scale while preserving the localism and ‘expert generalism’ of general practice”.

The report also emphasised the need for the Government and NHS England to manage their expectations “of what large-scale primary care organisations can achieve”.

Rebecca Rosen, a Nuffield Trust senior fellow and GP said: “Most English GPs are now joining large organisations, and this research shows how that can help to keep practices going after years of financial pressure and rising workload. What they need now is time and support to develop good relationships with other parts of the NHS, and to make the investments needed to realise long-term benefits.

“It is important that political and NHS leaders don’t let expectations of these new organisations run away from the reality. These are early days, but so far we see no sign that larger organisations are leading to better standards of care. Taking on new services is a major task and will take time. These groups will have to develop much further before they can take on the very complicated task of managing change across the health service.”

The Nuffield Trust received responses from 94 CCGs (45% of all CCGs) and from 982 GPs and practice representatives, from 184 CCGs, representing 87% of all CCGs, who identified their affiliations with about 210 large-scale collaborations.

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