The RCGP has for some time now recognised that practices are choosing to work at scale to deliver services for patients. While the college is committed to supporting general practice in all its forms, the current political and contractual landscape - particularly in the wake of the Five Year Forward View - means that we are seeing a clear move towards 'at scale' delivery.
The current Supporting Federations Programme is commissioned by NHS England and is a collaborative project between the RCGP and The Nuffield Trust – its aim has been to listen to the profession and develop a learning network that provides factual support and an interactive platform for all practices making the decision to work in this way.
The challenges facing primary care are well documented and are multifaceted. We know that the workload in general practice has increased significantly over the last 10 years and the BMA’s Future of General Practice Survey tells us that 93% of GPs feel workload has had a negative impact on the quality of patient care. This is framed in a context of a reduced share of the NHS budget (8.4% in 2014 down from 11% in 2005) and an unprecedented workforce situation – fewer medical graduates are choosing to specialise in general practice.
Map: GP trainee vacancies
In parts of the UK we are seeing worryingly low take up of GP training places with a number of schemes being less than 50% filled for 2015/16. Furthermore as the NHS as a whole is contributing to increased life expectancy and our technology driven world delivers more advanced medical treatments and greater access to knowledge the needs of our population have evolved – we are seeing increasing frailty, increased medical and social complexity and a well informed public that must be directly involved in every aspect of their healthcare.
Successive governments have attempted to address the challenges faced by the NHS and their task is not to be underestimated. However the robust response to political intervention made by the healthcare profession, not least in recent times relating to junior doctors’ pay and seven-day working, must also be acknowledged and indeed applauded; it is essential and we are all thankful that we live in a society that is empowered to debate and influence at that level in order that the ultimate solutions are right for everyone.
The RCGP and other healthcare organisations continue to show proactive and positive support for General Practice: documents such as The Inquiry into Patient-Centred Care in the 21st Century, Building the Workforce – the New Deal for General Practice, A vision for General Practice in the Future NHS(7) and A Blueprint for Building the New Deal for General Practice demonstrate a healthy desire to support the evolution of general practice to ensure it remains the cornerstone of patient care in the UK and a specialty of choice for future healthcare professionals.
The Supporting Federations Programme is in a similar vein. We have carried out a survey of CCGs and GPs from July to November 2015. This survey has driven the content for our learning network - we have provided case studies and links to resources covering eight distinct topic areas determined by the feedback in the survey:
- Organisational Models
- Organisational Development
- Leadership
- Infrastructure
- Workforce
- Procurement
- Patient Involvement
- Research
A full summary of the results is available through the learning network - the key discussion points include the need to use standard terminology when describing federations, the importance of considering function before forming at scale organisations, the role of training and education in workforce evolution, motivators for working at scale and the impact GPs can have in a leadership role.
We have learned that the key drivers for at scale working are based on a desire to improve patient care – to extend services for patients, to improve clinical outcomes and to improve access to primary care – as well as to create efficiencies in back office function and to maximise the development of clinical and non-clinical staff.
The college will continue to champion the at scale agenda and is now looking to work collaboratively to focus on how it can support federations in delivering the highest quality care.
- The RCGP will be launching its Supporting Federations learning network on 1 December. To access the network and take advantage of the learning and networking it will offer, register at federations.rcgp.org.uk
- Click here for details of a 1 December Twitter chat on working at scale and a series of RCGP webinars.
- Dr Mike Holmes is RCGP clinical lead for the Supporting Federations Programme and a GP partner at the Haxby Group, in York and Hull.
