General practitioner GP practices England Northern Ireland Wales

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The context: GP networks and the pressures facing primary care

What are collaborative GP networks?

GP Networks is a broad term used to describe collective arrangements between two or more GP practices. They are often established to maximise effective working in the pursuit of one or more common aims.

The chosen collaborative model can vary significantly depending on the circumstances, and there is no one-size-fits-all approach. The following options are not exhaustive and GP practices could adopt more than one arrangement for different purposes:

  • Simple networks / Formal and informal joint ventures
  • Joint premises
  • Partnership mergers
  • GP cooperatives

The above arrangements may fall under one or more of the following legal structures  :

  • GP partnership agreement
  • Private companies limited by shares
  • Community interest companies and social enterprises
  • Charity or charitable incorporated organisation
  • Limited liability partnerships (LLPs)
  • Private companies limited by guarantee
     

What are the challenges faced by Primary Care?

The Health and Social Care Act 2012, which came into effect on 1 April 2013, brought about the advent of clinical commissioning groups (CCGs) and new procurement and competitive tendering rules. Whilst presenting traditional General Practice with considerable challenges, this also gives rise to some significant opportunities.

  • The demands from the UK governments, including the 2013-2014 contract imposition in England have not only increased the workload of already over stretched practices but have also reduced investment in the GMS contract.
    Read more on the 2013/14 contract imposition in England

  • In England, many practices, already operating at the limit of their resources, will soon find themselves under additional pressure to adapt to equitable funding changes (proposals will be implimented across the UK from April 2014).
     Read more on equitable funding

  • Add to this the uncertainty surrounding the future responsibility for unscheduled care, and this combination of stresses on the profession is leading up to a recruitment and retention crisis in General Practice.

  • Significant financial (NHS to make efficiency savings of £15-20 billion between 2011-2014, challenge set by Sir David Nicholson, Chief Executive NHS England in 2009) and patient demand pressures on all sectors of the NHS have resulted in an urgent need for efficiency gains and greater integration between primary, secondary and tertiary care services. GPs need to be the leaders of this integration, and GP practices are best placed to continue providing high quality primary care services for NHS patients.

  • The imminent plans for equitable funding are likely to be a key facilitator for change.  A fairer funding landscape has the potential to reduce geographical variation in services. Equally, practices that face reductions to their core contract funding will need to evolve and consider economies of scale simply to maintain levels of access and their range of patient services.

  • Opportunities for diversification and entrepreneurial behaviour, particularly in accessing different sources of income, can be utilised as a means for survival.

  • Practices should be preparing for the future in terms of the political context too. This brings with it the risk of large private healthcare corporations bidding to deliver a greater range of primary care services.

 

Next: How can GPs prepare and why form GP networks?