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Is bigger better? Lessons for large-scale general practice

Updated on Friday, 3 August 2018, 2031 views

The report looks at pooling GP resources and the impact that this will have.

The BMA Public Health and Healthcare team have done a very useful summary of the report which is below for information

Summary: Is bigger better? Lessons for large-scale general practice (Nuffield Trust)

Key findings

Rate of formation


Patient involvement and experience

Patients had mixed views. Some valued new forms of access offered by the larger organisation but others voiced concerns about losing the ongoing, trusted relationship with their own general practitioner (GP) and their own practice.

Extending the range of services

Realistic expectations

Models of change

Economies of scale


Creates new opportunities to strengthen and diversify the workforce.


Clarity about goals and values

Goals generally included:

• Invest the time needed to agree the purpose, values and short- to medium-term goals of the organisation.

• Consider including specific and measurable quality improvement goals that are consistent with local commissioning priorities in order to improve care, build relationships with the local CCG and create a rationale for CCG investment in the organisation.

• Invest time and resources to develop staff roles across practice boundaries and to create peer support and peer learning opportunities.

• Design the simplest governance arrangements possible to deliver agreed goals and be prepared for them to evolve and become more complex. Agree the level of decision-making authority to be ceded by member practices to the board that will best balance the pace of change with ongoing engagement of member clinicians.

• Ensure that resources are available to achieve agreed goals and be clear about the level of risk (in terms of investing money and/or resources) that members are willing to take to attain these.

• Engage with patients to design services that address diverse needs and preferences.

• Where member practices are seeking to establish extended services, ensure that these are underpinned by positive, collaborative relationships and shared goals with specialists.

Recommendations to clinical commissioning groups

• Have realistic expectations about the capacity of large-scale general practice organisations to take on extended roles and develop new skills and services.

• Facilitate local debate between patients, the public and other stakeholders about how best large-scale general practice organisations can contribute to population health improvement and what other part they might play in the local health economy.

• Follow guidance on conflicts of interest, but avoid excluding GPs with an expert knowledge of a specific area of care from service redesign work.

Recommendations to national policy-making and research bodies

• Ensure a phased introduction of the alternative contract for large-scale general practice organisations and MCPs.

• Acknowledge the time needed for large-scale general practice organisations to develop

• Commission research on the impact of larger-scale general practice organisations on the quality of core services; the extent to which they deliver the ‘expert generalism’ and continuity of relationship that is valued by patients; and their impact on use of other services.

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