Exclusive: Merging 'may be necessary' to fix some practices, RCGP warns

Merging may be the only route to survival for some practices with recruitment and financial problems, the leader of the RCGP resilience team set up to deliver turnaround support has said.

RCGP vice chair Dr Martin Marshall
RCGP vice chair Dr Martin Marshall

RCGP vice chair Dr Martin Marshall said the RCGP resilience scheme, launched this month, had been adapted from the peer support scheme the college has run for practices in CQC special measures over the last two and a half years.

It is intended to help practices get ‘back on track’ and combat workload and workforce problems.

The scheme will not shy away from recommending drastic action, he told GPonline, warning that evidence from the CQC special measures scheme had shown the best solution for some practices may be to merge or 'hand in the keys'.

GP resilience

Costing £7,500 per practice, interventions will mainly be funded by CCGs, supported with cash from NHS England’s general practice resilience fund – although practices also have the option of self-funding.

A total of £16m was available under the resilience fund last year – but only £2.5m was allocated, helping just 219 out of 1,453 eligible practices. An additional £8m is on offer per year till 2020.

Dr Marshall said the team would take forward what it had learned running the special measures support programme, which will cease to exist from October when the CQC overhauls its inspection process.

Although open to a wider range of practices, the new scheme will still be based on the CQC’s framework and assess whether practices are in line with the watchdog’s key lines of enquiry – safe, clinically effective, caring, responsive and well-led.

‘Any of those could be looked at,’ said Dr Marshall. ‘Some problems might be more business orientated, some more financially orientated – it really does depend on need, and we have the expertise to provide.

Clinical support

‘The unique selling point of our offer is we are sending in experienced clinical managers rather generic managers you'd might get through conventional management schemes – people who really understand the issues from a practical perspective.’

The RCGP has assembled a 70-strong team of experts including GPs, practice managers, nurse practitioners and pharmacists to run the scheme.

Once called in, the team will make an initial assessment to determine what the issues are with a practice, before drawing up an action plan and tailored support.

Some may require a diagnostic intervention over a few months to determine the nature of the problem, while others may need more intensive aid to manage access, patient flow, finances or set up new practice nurse teams.

Some may require serious action. ‘For some of the practices in the special measures work we did originally, the only solution was for the practice to cease existing – the lack of local support they had meant there was no option but to hand in the keys,’ said Dr Marshall.

‘While that is never a desirable outcome it is sometimes the only one and a reasonable one from an intervention.’

He added: ‘Merging might sometimes be necessary. Our experience where that was necessary in our earlier scheme is that the partners will often breathe a sigh of relief when they hear that.

‘They probably recognised in their own heart that it wasn’t working and really welcome the support and encouragement they're getting from a colleague. They’ve done all they can but they can't carry on.

‘That is the advantage of our offer – of experienced grounded peers going in – it’s really that peer support rather than cold-hearted management offer.’

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