Super-practices offer a chance of survival

For all the government's hype, practice based commissioning (PBC) is likely to prove a huge waste of time and money because it merely inserts an extra layer of expensive bureaucracy between the GP and the hospital. But tweak it and some unintended benefits may emerge.

Instead of each PBC group being a loose consortium of practices, why not merge them administratively into one super-practice, but continuing to operate out of the same smaller-sized, personalised surgeries which patients like so much? A conglomerate would have all the benefits of scale while retaining the personal feel of its constituent practices.

Just think of the savings. Instead of 12 practice managers all creating identical protocols, data returns and tax forms, a single consortium manager would do them all leaving much cheaper office managers to run each sub-practice.

A centralised telephone appointment system would be economical on staff time, as would centralised quality framework target-chasing.

With all practices joined administratively and sharing the profits, there would be less infighting over who received development or buildings' money from PBC savings. The buying power for such a consortium would be far greater than that of its individual practices. Dealing with extended opening would be achieved on a much more acceptable rota basis, and the consortium would be able to provide improved cover for holiday and sickness in both clinicians and staff. Shared cover would allow GPs in the smaller practices to bring their specialised talents into providing GPSI-style clinics.

The only problem would be of retaining full MPIG and PMS payments. One way would be to retain each surgery's legal identity within the consortium's administrative framework.

PBC is currently on a hiding to nothing. By converting the PBC consortium into the new, distributed super-practice of the future, GPs will achieve an efficient structure for the local NHS. A distributed super-practice is the only primary care structure that can resist the threat of the extended-opening Darzi and franchised APMS clinics while simultaneously retaining continuity of care.

Dr Lancelot is a GP from Lancashire. Email him at

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