NHS England has been advised to encourage GP practices to “scale up” by creating a new type of contract and delegating more primary care budgets.

A report commissioned by the NHS has recommended several moves to help achieve increased “scale, scope and organisational efficiency of general practice”. The report, published by the Nuffield Trust, says this will enable improved and extended services.

It recommends NHS England should set a “national framework” for developing primary care, including out-of-hours, and give more support.

It also calls for “a new alternative outcomes-based contractual framework for primary care which allows a high level of local adaptation” and “delegated rights for clinical commissioning groups” to commission GPs. Currently NHS England holds the vast majority of GP budgets centrally.

The report, commissioned by the now abolished NHS Midlands and East, highlights different models for extending GP services. These include single “super partnership” practices, multi-practice providers such as The Practice, and federations of practices.

NHS England is in the early stages of work on a primary care strategy, which may be published around the end of the year.

The government indicated earlier this year it supports changes to GP contracts, with the aim of improving coordination and out-of-hours care. It is expected to work with NHS England over the summer and publish further plans in the autumn.

Ministers and NHS England are likely to make policy decisions including on whether to introduce a new GP contract, and changing out-of-hours arrangements, later in the year.

NHS England head of primary care for Midlands and East Jill Matthews told HSJ: “[The Nuffield report] will stimulate thinking in primary care on how to organise, while retaining the characteristics of general practice that are valued by the public and make a significant contribution to the effectiveness and efficiency of the NHS.

“I hope the report and the models [it highlights] will contribute to the evidence base for the NHS England [strategy]. I believe there is a real opportunity to support general practice as it considers how to create sustainable scale and potentially expand the scope of what it can offer.”