GP sector sees 'boom' in large provider companies

The increase has been attributed partly to national policy changes, including clinical commissioning groups taking on responsibility for primary care contracts, by CCG and GP leaders.

One law firm alone has established over 60 GP “provider groups”, while the Royal College of GPs has begun working with the Nuffield Trust to keep track of the rapidly developing sector.

It is believed that most of the groups are being set up as independent profitmaking companies, which unlike more informal GP federation structures, allows them to hold contracts to provide services, while limiting the liability to member practices if the firm goes bust.

Analysis of the “vanguard” sites, which are trialling new care models in line with the NHS Five Year Forward View’s recommendations, also reveals that these entities have only very recently been established by groups of GP practices.

Of the 23 areas working to set up primary and acute care systems or multispecialty community providers, all but five have a GP provider group or federation listed as a partner.

Most of these were set up in 2014 or 2015. One – South Cumbria Primary Care Collaborative, which is part of the North Lancashire and Cumbria vanguard – was incorporated on 26 March, two weeks after the vanguard sites were announced. West Wakefield Health and Wellbeing, Tower Hamlets GP Care Group and Yorkshire Health Network Limited are among the others established in the past 12 months in vanguard areas.

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Birmingham CrossCity CCG chair Gavin Ralston told HSJ it had actively encouraged its member practices to form Big Practice, a provider group covering 80 practices that was incorporated in December. The group will bid for sexual health, anticoagulation and out of hours contracts too large and risky for a single practice to take on. He said he hoped the group would improve the quality of primary care across the city, and that this will alleviate pressure on other parts of the system.

Oxfordshire CCG clinical chair Joe McManners said large provider groups were easier to commission from than individual practices. He added that the prime minister’s challenge fund, which GPs can bid for to pilot new ways of working, had also provided a “catalyst” for practices to scale up.

RCGP chair Maureen Baker told HSJ she believed there was a “boom” in new large scale primary care provider companies.

She said: “I expect it is more likely that practices will want to collaborate in ways that will need a legal entity, so this is likely to grow.”

CCGs taking on delegated responsibility for primary care commissioning was also a “reasonably significant” factor, she added.

“With the forward view, there’s very much a sense that these can only really move forward if you’ve got some sort of federation structure – you don’t move into new models of care as a single practice.”

Ross Clark, a partner at Hempsons who worked with the RCGP to produce a “toolkit” for practices wishing to federate, said he has been involved in setting up over 60 provider groups – about a quarter of which were in the past year. Collectively, these groups now cover a GP registered population of 16 million.

He said the government’s decision to phase out the minimum income guarantee for practices had prompted some GPs to establish joint arrangements, fearing that their businesses would not be viable in their current form in the long term.