Exclusive: Huge surge in GP collaboration to deliver services at scale

Three out of four GPs now work in collaborative arrangements, with 44% of these new ways of working set up in the past 12 months, according to research by the Nuffield Trust think tank on behalf of the RCGP.

Financial pressure in general practice, encouragement from CCGs and the drive to expand primary care services are among key factors driving the shift to collaborative working, the research - seen exclusively by GPonline - reveals.

Two thirds of the collaborative systems adopted by GP practices are federations, with only a tiny proportion (2%) choosing to form super-practices, the research suggests.

Findings from the RCGP-backed research were unveiled as the college prepares to launch an Online Learning Network on Tuesday 1 December, developed with the Nuffield Trust as part of the RCGP Supporting Federations programme.

General practice at scale

The programme, commissioned by NHS England, seeks to obtain a better understanding of the formation of networks of practices and to support practices in scaling up into larger general practice organisations.

A total of 73% of GPs and practice representatives who responded said they worked in either formal or informal collaborative arrangements.

Of the 982 GPs and practice staff in 184 CCG areas across England who took part, 37% were part of a formal collaborative system, and a further 26% part of an informal collaboration.

The research found that 42% of collaborations were set up as private limited companies, with just 8% community interest companies. Two thirds of the groups cover populations over 50,000 patients and 84% operate within a single CCG area.

Pressure on GPs

The findings reveal that collaborative working has taken a significant amount of time to get off the ground. Most focused initially on extending services and investment in staff and training, but in many areas the full benefits took two years to materialise. GPs involved in collaborations also reported a struggle to engage practices that were under significant pressure and had little time to spare.

RCGP Supporting Federations programme lead Dr Mike Holmes said: 'There is no doubt that the challenges we are currently facing in general practice are contributing to the decision to work at scale. However our survey is clear that the most common reasons given relate to patient care – extending services, improving clinical outcomes and increasing patient access to primary care. In addition there is a clear desire to support development of our staff in primary care and enhance the effectiveness and efficiency of our back office teams.'

Stephanie Kumpunen, who led the research for the Nuffield Trust, said: 'This survey underlines that GPs must be given time to deliver better results through working in larger groups. Bigger scale is important for improving general practice, but it can’t be seen as the answer to everything. Groups need to keep their purpose clear and focus on just a few realistic aims.'

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