Exclusive: Loss of control and time dominate GP fears over working at scale

Loss of independence, not having enough time to develop a network or federation and concerns over funding are the top three issues GPs say are putting them off working at scale, a poll reveals.

Almost two in three GPs (64%) responding to a GPonline's poll carried out in association with medical defence organisation Medical Protection chose loss of independence among their top three concerns about federating or working at scale.

More than half (56%) of the 294 GPs who took part in the survey specified a lack of time and capacity to develop a network or federation among their top three concerns with working at scale, and 48% said financial issues were in their top three concerns.

Problems with governance or leadership of large-scale GP organisations was also a significant issue for many GPs, with 45% listing this in their top three concerns. Many also highlighted concerns that larger provider organisations would undermine continuity of care.

General practice at scale

Despite concerns about the impact of working in larger organisations, the survey suggests that many practices are using networking arrangements to bring additional staff into their practices. Three out of five respondents said their practice, federation or network employed a pharmacist.

A GPonline poll earlier this year found that just a third of GPs said their practice directly employed a pharmacist, suggesting that many more have access to one through collaborative arrangements.

Although 14% of GPs said their practice planned to join a federation, network or super-practice in the next 12 months, only two in five respondents to the GPonline/Medical Protection poll said their practice was currently part of one of these organisations.

This appears to be at odds with recent findings from research carried out by the Nuffield Trust on behalf of the RCGP, which suggested that three quarters of GP practices were involved in some form of collaborative arrangement.

Large practices - and those working in collaboration with others - are likely to score higher CQC ratings, according to an analysis published last year by the watchdog.

GP workforce

GPs responding to the GPonline/Medical Protection poll were fairly evenly split on whether working at scale would help improve patient services. Around a quarter said it would, while a quarter said it would not and the rest were unsure.

One GP who was concerned about the impact of networking or federating said at-scale general practice schemes were 'privatisation by the backdoor', warning that some work that had shifted from practices to a local federation was no longer pensionable.

Others said larger organisations could mean more meetings, bureaucracy and worse patient care.

But other GPs said they had seen benefits from collaboration, through sharing best practice with other local surgeries, and developing services or hiring staff with pooled funds that individual practices would have been unable to afford.

Photo: JH Lancy

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