Large-scale GP provision has cut patient satisfaction and failed to improve quality, study shows

The widespread development of large-scale GP provider organisations has so far failed to improve quality and is linked to falling patient satisfaction, a study has found.

While three quarters of GP practices are now part of some form of collaborative organisation, such as federations and networks, the Nuffield Trust research found no marked improvements in quality of care compared to the national average.

The 15-month study, which analysed 15 care quality indicators in large-scale organisations across England, found no evidence of consistent improvement over time or reductions in organisational variation between member practices.

Looking at patient experience, the researchers found that while some valued new forms of access that were available, others were concerned about the loss of a personal relationship with their GP.

The study found patient satisfaction deteriorated over time. ‘Surprisingly, patient satisfaction measures assessed by the national patient survey appeared to deteriorate over time, despite local efforts to improve access in each site,' the report said.

New models of care

Initiatives to extend the range of services provided were ‘mainly small scale’ the report said, and none of the organisations studied had tried to redesign care delivery across a specialty or operated at the scale envisioned for new care models.

But the research did find that larger-scale organisations can help ‘improve sustainability in core general practice through operational efficiency and standardised processes, maximising income, enhancing the workforce, and deploying technology’.

The researchers called on larger-scale practice groups to consider new quality improvement goals consistent with local commissioning priorities, and ensure resources are available to achieve goals.

National policy-makers should ensure a phased introduction of the alternative contract for large-scale practice and MCPs as there is ‘currently insufficient evidence’ it will deliver high quality, cost effective care, the report said.

Nuffield Trust senior fellow and GP Dr Rebecca Rosen said: ‘It is important that political and NHS leaders don’t let expectations of these new organisations run away from the reality. These are early days, but so far we see no sign that larger organisations are leading to better standards of care. Taking on new services is a major task and will take time. These groups will have to develop much further before they can take on the very complicated task of managing change across the health service.’

Large-scale general practice

RCGP chairwoman Dr Maureen Baker said: ‘More research needs to be done to evaluate the long-term benefits of GPs working at scale, and there are challenges that need to be addressed, but it is certainly encouraging that this report has found quality has not reduced as a result of large-scale general practice. The college will continue to work with the Nuffield Trust and others to support any GPs who are interested in working at scale, through our Supporting Federations programme.

'Ultimately, we need the necessary funding and resources – as well more GPs and practice staff – to ensure patients continue to get the quality care they need and deserve. NHS England’s GP Forward View was recognition of the importance of general practice in our health service - we now need to ensure that the pledges are delivered effectively and as a matter of urgency, in the best interest of our patients and GPs.’

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