Working together in general practice
The developing role of primary care, built around general practice, is at the heart of transforming the delivery of healthcare in the UK. The Primary Care Foundation has worked with increasing numbers of groups of practices to explore how practices might work together.
Working at scale, or groups of practices exploring how to get the benefits of working together where it makes sense, has developed at pace over the last few years. From our work, there are four main observations about general practice working together:
- The shift towards practices working at scale is now irreversible – most practices are now part of a network, or federation, or Primary Care Home, or provider company
- It works well where it starts with a clear sense of purpose and real sense of ownership rather than imposition
- It requires thought about doing the right thing at the right level, not managing all tasks together – the best models focus as much on what can be devolved to front line teams as what can best be done at scale
- It can provide a different way of talking to general practice as part of the extended health community e.g. STPs
Case Study: developing federations in London
We worked with three sites across London through the London Office of CCGs to develop practice federations, as well as running events and developing longer-term support for other areas across the Country.
We encourage practices to think through carefully the purpose of working together rather than simply being driven by national policy or local pressure. There are real strengths in the traditional model, built on continuity of care with small practices responding rapidly to changing needs. Practices often need to learn more about each other and how they are working now before thinking about what they might do in the future.
But in a climate of financial austerity more practices are finding it difficult to balance their budgets while, at the same time, the expectations of both patients and the healthcare system continue to increase. Practices are looking to work together on a wide range of issues including:
- Shared back office functions and joint purchasing
- Sharing clinical expertise across a wider group of practices
- Introducing access to extended hours in a co-ordinated way
- Responding to tenders from local commissioners for current services (LESs) or new service developments
- Shared training and education for all staff in general practice
- Implementing common information systems so that patient notes can be accessed across all practices and, potentially, the wider health and social care system
- A shared approach to supporting frail elderly people with complex health needs
- Creating integrated primary care teams that connect general practice, community services, community pharmacy and third sector agencies.
We also can offer support to think through the organisational and governance issues of working together. We always encourage practices to think through the purpose and function before the organisational form, but understanding all the advice and support they need and establishing effective and transparent decision-making processes is important.