Analysed: Practices urged to work at greater scale

At its board meeting last month, chief executive Sir David Nicholson said “individual practices will need to work together across a bigger community and bigger geographic footprint” to turn primary care into “something we can do at scale”.

The 2014-19 planning guidance, launched at the meeting, said NHS England and clinical commissioning groups had a “joint responsibility to drive up all aspects of quality in primary care services”.

It added: “There is a growing consensus that this will mean enabling general practice to work at greater scale and in closer collaboration with other health and care organisations.”

However, speaking to HSJ, NHS England deputy medical director Mike Bewick insisted the national body would not “use this as a lever to rid ourselves of single-handed practices” and that there would be “no compulsion” for practices to federate.

He explained the guidance was about finding the best ways to build capacity in primary care − something which “individual practices might struggle to do”.

David Sharp, NHS England’s Leicestershire and Lincolnshire area team director, said he wanted practices to remain legally separate entities and “have a limited agreement to work collectively”.

However, Dr Bewick said if a single-handed practice had major problems area teams could “put in measures to ensure the contractual obligations are fulfilled”.

Mr Sharp said practices in breach of their contract would have to collaborate with their counterparts, for instance with six or seven of them working weekends on a rotating basis if they wanted to avoid closure.

“If there’s a small, single-handed practice in Leicester with an ageing GP and a poor estate and they didn’t want to federate, I would know what my answer was and it probably wouldn’t be a very nice one,” he said.

He added that his area team had been having conversations with about a dozen inefficient practices to warn them it was “only a matter of time before… [they] fall foul of some significant quality or financial risk”.

Mr Sharp said the guidance would show GPs national policy was being pursued “with some purpose and conviction” rather than just to save money.

Mike Burrows, director of NHS England’s Greater Manchester area team, said there was already “a lot of latent interest out there in primary care for working in new models of collaborative work across practices”.

Last summer, 22 groups of GP practices in Manchester made bids to be awarded “demonstrator grants” from the area team. Six were selected.