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New organisational models for general practice:. Dr Rebecca Rosen Senior Fellow The Nuffield Trust General Practitioner South East London December 18th 2013. 13/11/2013. Overview. Why do we need to think about changing general practice? New models of practice organisation

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new organisational models for general practice

New organisational models for general practice:

Dr Rebecca Rosen

Senior Fellow

The Nuffield Trust

General Practitioner

South East London

December 18th 2013


  • Why do we need to think about changing general practice?
  • New models of practice organisation
  • Strengths and weaknesses of different models
compelling case for change inter national context
Compelling case for change: (inter)national context
  • Primary care is having to balance financial constraints with rising demand
  • Widespread shift in services from hospital to community is adding to demand for GP services
  • Public expectation is rising
  • Unwarranted variation between practices in many areas of evidence based practice (Kings Fund, 2011)
  • Fragmentation: Practices operate in relative isolation, without formal links with other services
  • .
compelling case for change practice perspectives
As small businesses GP practices are vulnerable to marginal reductions in income – need to diversify income streams

Typically have insufficient staff to accommodate new clinical, administrative & regulatory roles & requirements

Reduced income requiring more efficient business model

Potential to increase scope of business but need scale

GPs are becoming burnt out and open to wider variety in their working lives

Some are slightly bored of the status quo and looking for a fresh challenge

Compelling case for change: practice perspectives
making it happen new organisational models for general practice
Making it happen: New organisational models for general practice

Super partnerships: Large practices on several geographically local sites. Formed through practice mergers. GP led. Single legal entity created.

Networks and federations: Collaboration of local practices, which remain independent. The collaboration may be informal (a network) or formalised as a legal entity which can hold contracts. The aim is to increase scope of provision and create efficiencies whilst maintaining core small business model.

Regional and national multi-practice models: Multiple practices distributed on a regional or national basis, owned by a single parent organisation which may be a traditional GP partnership or a public or private company.

Community orientated practices : GP practices embedded in local community and taking a holistic, population focused approach to general practice – linking health and wellbeing to employment, skills and social networks

super partnership model
Super partnership model

Main characteristics:

Keeping what’s good about ‘small and local’

Built on local general practice with local GPs

Delivery at scale: 80k+ patients: practice mergers

Expanded general practice teams

Clinically and quality focused, managerially smart

Integrated planning and delivery of generalist, specialist and community services

Provider-led population health care management

Foundation for large education provider

networks and federations tower hamlets
Networks and Federations – Tower Hamlets

London Borough of Tower Hamlets has established eight GP networks

Main characteristics:

36 practices were formed into 8 networks 2006/7.

Geographically aligned. 4 – 5 practices per network.

Initially formed to improve diabetes care, then extended to address other conditions

Substantial PCT investment (£8m over 3 years) in admin staff to support networks, IT, care planning and incentives for quality improvement

Focus for peer led change and improvement with a linked education and training programme

Care coordination enabled by care planning, shared electronic record and monthly MDT mtgs

Peer led performance review against KPIs for incentive payments

networks and federations suffolk federation
Networks and Federations – Suffolk Federation
  • Main characteristics:
  • 40 original practices invested a fixed payment (30p per patient) to join the federation – now 60.
  • Membership organisation governed by a board of 9 GPs, 3 practice managers and the CEO
  • Each practice has 1 vote for strategic decisions
  • Covers a population of 539,000 patients
  • Formed to win contracts for extended services. Portfolio of services now covers:
  • Diabetes, Ultrasound, lymphoedema, cardiology and urology
  • Diversifying roles into practice support including running a locum bank, HP and procurement

Formed between Suffolk GP practices, April 2013

multi practice models
Multi-practice models
  • Main characteristics
  • Partnership and PLC versions
  • Run multiple practices and services through multiple contracts
  • Variety of services offered: standard general practice; urgent care centres; walk-in centres
  • Geographically scattered
  • Variable governance arrangements
  • Examples: The Hurley Group, The Practice PLC
proactive population focused health care bromley by bow healthy living centre
Proactive, population focused health careBromley by Bow Healthy Living Centre
  • Health – GPs, community nurses, health networkers, artists, gardeners, community care workers and a youth team to explore and create new ways of thinking about health in a holistic way.
  • Enterprise – ‘Enterprise Hub’ - eight social businesses helping people return to work
  • Art use of art as a vehicle for breaking down boundaries and promoting better health
  • Learning – ESOL, sewing and art groups, plus opportunities for NVQ, HNC, HND qualifications (eg working within the centre café)
  • Environment – a high quality environments which raise aspirations and boost self-esteem.
  • Creche – supporting opportunities for working parents to return to work
making it happen essential ingredients
Strong clinical leadership and GP engagement

Clear vision for the organisation(s) who are trusted by their peers

Time and skills in leaders/belief it’s work making the effort in followers


IT systems for shared records and data analytics

Telehealth and telemedicine

Education and training

Organisation and workforce development

New models of governance

Skilled managerial support and resources for OD

Developing skill-mix and increase multi-disciplinary working

Financial logic

Contribute to financial stability of practices

Making it happen: essential ingredients
concluding thoughts
Concluding thoughts
  • Need to decide core aims for working together and then decide which model fits best
  • Unlikely to get agreement between all local GPs. Let enthusiasts lead the way and others can follow if they want to
  • Develop clear values and goals and ensure local leaders communicate these to all involved – to develop organisational culture and drive change
  • Essential to have management skills & capacity to develop new models at pace
  • ? Need to have a single model in each CCG?
          • Minimum population?
          • Like minded?
          • Local rivalries vs burying hatchets!