GPs behind the innovative model - which has 36 GP partners and one non-clinical managing partner receiving equal profit shares - say it offers a sustainable model of general practice that has helped expand and improve patient services, while improving recruitment.
Other groups of practices in London and elsewhere in England are understood to be considering similar plans - suggesting it could form a blueprint for a wider shift towards GP-led provision of general practice at scale.
The 90,000-patient list was created on 1 January by merging 15 contracts across 14 sites in Enfield, north London. The 14 sites are run by Medicus Health Partners - a GP partnership set up in 2018 that initially brought together 11 practices and has since added four more.
The partnership's unified patient list is roughly 10 times the national average and second only in size to the patient list held by the controversial GP at Hand service.
However, while GP at Hand uses a 'digital first' model to serve a population predominantly aged between 20 and 39 years old spread across a large geographical area, the Medicus service is built around a group of practices in one area serving a traditional cross-section of patients.
It is one of a growing number of 'superpartnerships' across England, some of which involve more than 100 GP partners across patient populations well into six figures. Medicus stands out because of its shift to a single contract - while most large-scale GP groups have retained multiple practice contracts - and considers itself a ‘superpractice’.
More than 1,400 GP practices have been lost to mergers or closures since NHS England became operational in 2013 - and the number of full-time equivalent partners has dropped by 18% in the past four years alone. But while the Medicus merger will on paper contribute to the loss of GP practices, sites in operation will remain unchanged - and the GPs involved say the model will protect against the loss of partners that has come with the closure of standalone small practices.
General practice at scale
The partnership has no corporate involvement - and effectively operates as a traditional partnership, but at scale. It has set up a limited company because commissioners wanted a single name on the contract for a violent patient service the group now runs - but the company accounts for just 1.5% of turnover.
The 36 GP partners are all based at specific practice sites, and along with the managing partner all were named on each contract held by the group prior to the merger. Practices within the group have run as a unified partnership since 2018 - and felt from the outset that a single contract was the way forward, although the move was delayed until confirmation came that a merger would not require putting the service out to tender.
Partner Dr Ujjal Sarkar told GPonline that the motivation behind bringing practices together had been to level up primary care across Enfield - and that the move was in part borne of frustration with slow development of primary care services across the patch.
Dr Sarkar said working at scale had improved resilience across the group - patients were unaffected when a site serving 13,000 people was hit by a COVID-19 outbreak last May, because they were offered face-to-face or remote appointments at other sites. He added that the group's scale meant it could run 'probably one of the busiest vaccination sites in London' - offering up to 1,000 jabs a day, with no impact on business as usual.
The group has reduced back-office costs by operating at scale - with a former hospital finance director among its leadership team - and has been able to invest as a partnership in developing new services rather than waiting for commissioners to offer funding.
He said: 'It's very much bottom up. It's not a company - but it was our intention to move away from the smaller-scale cornershop model of general practice, to get all the benefits of a corporate model, but with the benefits of a partnership that couldn't be sold off.
'Medicus Health Partners is a partnership with 36 GP partners and a managing partner bound by a partnership agreement - it's not something that's going to be sold to a US corporation in future, because the partnership model is so strong.'
Fellow partner and Medicus Health Partners chair Dr Manish Kumar said the model had boosted recruitment and helped expand services available to patients.
Dr Kumar said: 'What we've found with salaried GPs particularly is they felt a bit more comfortable coming to a larger organisation than joining a small practice. We can offer development opportunities, training opportunities.
'My own site was a 4,500-patient list size practice. Pre-Medicus it was two partners, a practice nurse and a very standard operating model - a year or two later we've got access to emergency care practitioners, we have pharmacists on site, we have cross-site booking for contraception and minor surgery - and all of a sudden the opportunity for our patients has expanded dramatically.'
Managing partner Tara Sarkar said Medicus was ahead of the curve in terms of bringing in the types of staff now being recruited through PCNs and the additional roles reimbursement scheme. The group has linked up with another eight practices in the local area to form one of the country's largest PCNs, the 160,000-patient Enfield Unity PCN.
Ms Sarkar - who leads on operations, workforce and other aspects of the group’s work - said the model’s success was dependent on ‘like-minded people’ coming together with a shared view of how to use the benefits of working at scale to expand and improve patient care.
The belief GPs involved have in the model is perhaps reflected in the fact that around half of current Medicus partners lost income when they first chose to join, because of the group’s commitment to equity - and equal income - between partners.
Dr Sarkar said: 'We're in our third year and it's a journey - we haven't got it completely right yet. But we really believe in this, we're very passionate about it. And we would love to get people more interested in doing this themselves, getting out of their small silos, and thinking about the patient by working collaboratively.’