General practice remains overwhelmingly dominated by providers on single sites with small lists, providing little beyond “core” services, HSJ analysis reveals.

The findings highlight the scale of the challenge involved in cultivating the landscape of large and extended GP provider models, which is currently being sought by national officials and policy experts.

However, our analysis of the GP provider sector also identifies about a dozen emerging large scale operations working over multiple sites and with the biggest operator’s practice list stretching to more than 170,000 people. A small number provide services significantly beyond core GP work, such as specialist clinics, proactive community health services, diagnostics and urgent care.

The research is the most comprehensive analysis of the current landscape of GP and linked providers publicly available, and is based on the Care Quality Commission’s database of registered providers and sites.

HSJ’s analysis found that, of about 7,580 distinct providers registered in general practice and associated services, around 5,700 offered care at only one site. This group had an average registered patient list population of 6,500.

About 1,727 providers are registered to provide at two sites or at one registered site and a branch surgery. These branches are generally small, sometimes part-time and not required to register separately. A further 127 are registered for three to five locations. The vast majority appear to provide only “core” GP services and limited additional services.

Large and extended GP providers in England: table

Large and extended GP providers in England


also identified 92 providers with estimated populations of more than 20,000 across the GP practices they run or are linked to. The large national firm The Practice plc had the highest list of about 174,000 patients (see box, below).

A number of GP partnerships, companies and social enterprises – either providing general practice or strongly linked to it – also provide significantly extended primary care. This includes diagnostics, outpatient and community services, and urgent care and out of hours services. In the case of companies and social enterprises, they are often owned and led by GPs (see table, below).

There is little information available about GP federations, a type of network between practices promoted as a way of preserving independence while linking services. Only 16 federations are registered, and they have widely varying functions. Some have only come together to provide out of hours primary care. Several provide or coordinate extended primary care, diagnostics, outpatient or community services across an area. This is often combined with supporting practices with business functions, workforce or training.

The analysis comes as national policymakers and commentators push for bigger GP providers covering a wide range of out of hospital services.

NHS England has called for practices to “work at greater scale” and the Department of Health last year called for new contracts to combine core GP and other services.

Incoming NHS England chief executive Simon Stevens is known to be enthusiastic about a move towards multispecialty medical groups in which GPs work together with other doctors to make more specialised care available in community settings.

On Wednesday the King’s Fund published a report calling for GPs to form larger organisations that could be contracted both for core GP services and as lead providers for wider out of hospital care.

The think tank’s chief executive Chris Ham told HSJ existing models had “been able to do a little bit more but not much more” than traditional core general practice. “We need to go radically beyond the flexibilities [of current GP contracts] if we are going to bring about the transformation in out of hospital services that we have been arguing for,” he said.

  • HSJ is keen to hear about developing GP federations and other models offering or developing large-scale general practice and extended primary care. Email

Federations vs partnerships

Suffolk GP Federation serves a population of 540,000 at 61 practices across the county. Its chief executive David Pannell said working across such a wide geographical area allowed it to bid to provide services for NHS England and Public Health England. The federation has won a £10m diabetes contract covering all of Suffolk, and runs ultrasound and diagnostics services.

Mr Pannell said the federation planned to bid for other services currently operating in hospitals, and to provide services formerly run by primary care trusts including sexual health and smoking cessation.

Suffolk opted for a federation model over a full merger as its member practices wanted to retain independence. “Effectively our practices will be subcontractors to us and we would do all the contract management,” Mr Pannell said.

He said under the previous system of practice based commissioning - which was superseded by the government’s NHS reforms - “there were lots of very small provider groups set up by groups of GPs and the vast majority of them did absolutely nothing”. He said: “They didn’t have the scale to employ proper professional management who could go out to set things up and win work.”

The Vitality Partnership in Birmingham operates under what it terms a “super partnership” model, with its 10 practices operating as a single GP provider. Its services include dermatology, orthopaedics and neurology.

Managing director Sarb Basi said: “We genuinely believe that this is the way the profession has got to go.” He said the model enabled it to “use the registered list size as a foundation to develop an integrated care organisation”.

Mr Basi claimed that under a looser federation the interests of individual practices might not be aligned and many would pursue individual interests first. He said: “Inevitably you get to a point… [where] you’ll end up in conflict.”

Dominance of small GP practices undermines push for extended providers