General practitioner GP practices England Northern Ireland Wales

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Benefits to patients, the integration of the extended primary care team and the NHS

The Royal College of General Practitioners (RCGP) believes primary healthcare delivered by GP networks, organised to ensure patients receive high quality care from highly skilled GPs and NHS staff, will enable integrated working to become a reality for the NHS. (see note 1)

Whilst the Health and Social Care Act 2012 will undoubtedly introduce a greater degree of competition in the provision of healthcare services, practices that form collaborative or federative structures should be in a stronger position to bid for and win contracts commissioned by NHS England Area Teams, CCGs and Local Authorities.


How could this benefit patients?

Collaborative structures could enable patients to benefit from:

  • the existing patient-doctor relationship
  • an existing understanding of local patient need
  • local GPs’ experience of delivering high quality primary care services
  • better access to consultations provided in different sites
  • services closer to home and in reassuring settings
  • patient participation in the running of collaborative structures
  • a wider range of tailored services and continuity of care
  • an opportunity to build a more extensive community team involving community nursing, secondary care specialists and social care.

GPs should also bear in mind any possible disadvantages. These could include:

  • loss of autonomy
  • risk of small group of partners and large numbers of salaried GPs
  • reduced choice for patients that want to have different types of practices to choose from and
  • loss of local accountability


What are the benefits to practices?

The GPC acknowledges that single practices can and have developed additional specialised services already. However, working in collaboration enables practices to do this in a more comprehensive way, utilising the skills of more clinicians and ensuring a good range of services are available within a defined community.

If practices agree that there is logic in working together, the advantages of forming GP networks are three-fold.

  • Firstly, practices are the navigators and coordinators of NHS care for their patients. As GPs already know, a great benefit of collaborative working is the opportunity to develop a wider range of community services, whilst at the same time making more effective use of resource.

  • Secondly, better use of resources, including through the use of cost sharing agreements , and the potential to increase access to a wider patient population mean practices are well placed to generate additional income and improve their profitability.

  • Finally, collective strength can enable practices to offer commissioners services that cater for larger patient cohorts, across considerably bigger geographical areas .

    Collective strength could be important, since the introduction of additional providers into the NHS healthcare market suggests competition for enhanced services will be considerable.

    The generation of economies of scale is likely to be an important factor in competing with large private organisations when bidding for contracts. Being prepared to bid for and win contracts to deliver enhanced services may become vital in boosting practice income and maintaining viability in the future.

1. Field, S., Gerada, C., Baker, M., Pringle, M., & Aswani, K. (2008). Primary Care Federations: Putting patients first.
2. Cost Sharing Agreements (Cost Share Group Exemption - Group 16, Schedule 9 of the VAT Act 1994) – the exemption applies when two or more organisations (whether businesses or otherwise) with exempt and/or non-business activities join together on a co-operative basis to form a separate, independent entity, a cost sharing group (CSG), to supply themselves with certain services at cost and exempt from VAT.
3. Brought about by any qualified provider (AQP) arrangements introduced by the Health and Social Care Act 2012


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