Primary care organisations continue to face severe funding pressures. Practices are having to manage increasing costs, such as locum and indemnity costs, while also meeting quality standards.
These pressures are raising serious concerns about how sustainable the current model of delivering primary care will be in the future. An alternative to consider, which can help tackle the funding, recruitment and demand challenges individual GP practices face, is setting up a GP super practice - which is created through a formal merger of a number of practices into a single larger entity.
Steps to becoming a GP super practice
Once a practice has made the decision to join or develop a super practice there are a number of steps that must be taken to ensure it is set up in a way that meets local needs.
Creating a framework for co-operation. The first step is to understand who the key stakeholders are through identifying the first adopter GPs, their current practice leadership, the geographic area to be covered and relevant Clinical Commissioning Groups. Thought should also be given to potential future candidate member practices that may join later.
Scoping an outline of the super practice. The next step, once it is clear which practices are interested in joining, is to develop an outline of the proposed super practice. This should include a financial and geographic footprint, staffing arrangements and GP membership. Once an initial agreement on the scope and purpose of the new entity and likely member practices has been reached, a project plan and timeline needs to be developed. This will require agreeing an initial budget for scoping the proposal, as well as preliminary information sharing and decision making processes.
The detailed proposal. All parties then need to come together to discuss the detail. They will have to establish a consolidated financial position, an outline of the partnership structure, the opportunity for savings and efficiencies, profit-sharing arrangements, future entry or exit requirements, property and tax arrangements, as well as the approach to governance.
Regulator and stakeholder engagement. Once a detailed proposal document is in place, practices should discuss their proposals with local commissioners, NHS England, internal staff and other stakeholders, such as the Care Quality Commission. The focus should be on: understanding regulatory requirements; the views of staff and external stakeholders; the likely impact on contracts with commissioners; and existing financial and contractual obligations.
Planning, implementation and benefits realisation. When agreement is reached on the formation of a super practice, more detailed documents must be produced to help stakeholders manage the transformation process and the creation of the new entity. This should include: a detailed project plan and timeline; an interim governance structure and constitution; a vision and mission statement; an organisational structure; and terms of reference.
Getting governance right. Good governance is key for the success of the super practice and early decisions are needed about the level of autonomy it wants for individual practitioners within the structure. There are several governance options available to GP super practices wishing to merge. Governance should be underpinned by clarity over the overall leadership of the super practice. A strong, clear strategic vision is vital to drive success and the governance structure should support this.
Governance and decision making in Wyre Forest
An example of effective governance is the medium-sized Wyre Forest super practice. There is a clear scheme of delegation and governance processes to support decision making:
all partners delegate functions to a super partnership board and all partners meet around four times a year to set organisational strategy
the partnership board is made up of partner representatives from each site, a chief executive and chair. A patient representative also sits on the board to provide feedback from site representatives
the board meets monthly to oversee strategy and governance. It is accountable for delivery – delegating day-to-day running to the chief executive who has a management team covering specialist functions such as HR, finance, IT and quality
each site has a site manager fulfilling many functions of the traditional practice manager.