22nd November 2016
“You have to think anyway –
so why not think big?”
Donald J Trump
Isn’t it great when a quote and timing come together?!
There has been a lot of discussion about general practice working at scale, something the Federation have been considering for some time. Groupings are beginning into being across Suffolk, with Suffolk Primary Care and the Deben Health Group looking at working collaboratively, as are a group in Ipswich.
The CCG’s vision of neighbourhood networks, based on learning from the “connect “sites, also plays into this.
The benefits of working collaboratively seem to be clear:
- Economies of scale
- Ability to develop skill mix
- Streamlining and synchronising back office functions
- Management of property portfolio
- Standardised patient care
However, the Nuffield Report earlier this year was less positive, with the overall conclusion that they were “unable to detect marked differences in the quality of large-scale general practice organisations compared to the national average”. However, this doesn’t tell the whole story. I am not sure what would have happened in those areas without large-scale organisations and it doesn’t address the vital point that many of our younger colleagues do not see the traditional model of general practice or becoming a partner as something to which they aspire.
We have recently become aware that the “corner shop” model of general practice is not attractive to nurses, nurse practitioners or admin staff either as there is limited scope for development and personal growth.
So, what is the magic number? There is very limited evidence around what is an appropriate size of a general practice organisation. Primary Care Home which is running rapid test sites across Britain, has identified a size of 30,000 – 50,000. The report by Chris Ham and the King’s Fund had a broader range of between 25,000 and 100,000. That number was needed where practices took over global capitation fee for all healthcare because clearly the larger the size, the less the individual financial risk.
It was noticed that larger groups find it harder to make change happen. The additional complexity of adding in community services, mental health and social care into the mix makes things more complicated.
In summary – nobody knows the perfect size and it is unlikely that one size fits all.
Watch this space (or spaces).
Maybe it will be more like what the great early punk band, ‘The Replacements’ said
“Individually we were hopeless losers
Together we were a band ……….
Of hopeless losers “
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