Mergers or restructures within five years were predicted by 48% of GPs who took part in the annual healthcare confidence index - a measure developed by Lloyds Bank that relies on online survey responses and face-to-face interviews over a three-month period.
Of the 145 GPs who took part, 85% expected financial pressures to increase in the coming years. The survey also revealed a marked change in GPs' perception of how quickly the move to larger practices would come about - 72% of GPs now expect the average practice to have more than 10,000 patients by 202, compared with just 54% last year.
The findings come just weeks after analysis from GPonline showed that more than 250 GP practices covering almost 1m patients across England were either closed or merged in the past year.
General practice at scale
The confidence index results, compiled between November 2017 and January 2018, demonstrate a growing acceptance that practices will have little choice but to scale up their operations.
Commenting on the findings, GPC chair Dr Richard Vautrey said: ‘We are seeing a year on year increase in average list size as practices both grow as the population increases and increasing numbers merge together. This can bring economies of scale, make them more resilient and help practices cope a little better with the burden of bureaucracy.
‘However, as practices get bigger it is important to maintain the direct link with the local community and offer the continuity of care that is valued by patients.’
The report also found 'business confidence levels' improving among GPs for the fifth year in a row - although confidence levels remain low, at -37 on a scale from -100 to +100. Succession was highlighted as a potential driver for low confidence among GPs, with a third of GPs saying they intended to retire within the next five years and over half within a decade.
Bob Senior - head of medical services at acccounting and consultancy company RSM UK - said that although the demographic profile of GPs has always been relatively older, issues with succession could prove problematic in years to come.
‘The biggest challenge I see for most practices is sourcing enough personnel, which has meant increased workloads for many. That’s linked with the ongoing issue around GP succession, with practices struggling to replace GPs who are retiring and often ending up with a different mix of clinicians when they are unable to replace like with like.’
He added ‘GPs have always been less confident than dentists and pharmacists, perhaps because of the pressures that they see coming and the lack of people entering into the profession behind them. To that end, we’ve also seen an increasing shift towards practices merging. This is happening proactively too, with GPs taking a sensible, managed approach rather than waiting until it’s the only option left to them.’