Shaping the future direction · up to a perfect storm of increasingly unsustainable demands for its...

Primary concernShaping the future direction of primary care

Executive summary 1

Background 3

Redesigning the service user experience 8

Barriers to progress 11

Conclusion 13

Round table participants 14

About us 15

Contact us 16

Contents

Methodology

In response to the serious challenges currently facing the NHS and, in particular, providers of primary healthcare services, Grant Thornton held a roundtable discussion with a number of senior professionals within the sector. Participants ranged from those with financial expertise to medical practitioners, with the aim of obtaining a clearer picture of their hopes, fears and ideas for the future.

This report sets out these discussions covering: the current structural challenges faced by the primary care sector, the options available to respond to these challenges and the barriers to delivery. Through the use of illustrative case studies and analysis of sector intelligence, we present a number of recommendations.

Executive summary

“An alternative model of healthcare is inevitable ... whatever model of healthcare comes forward, primary healthcare will have a key role, and we need to be better organised to do it.”Round table participant

Key findings of the round table• The current arrangements for

delivering primary care are unsustainable in the medium-term. In the view of the meeting, significant numbers of GPs face the prospect of going out of business unless they adapt their business models. Practitioners must focus on generating additional income or reducing expenditure

• Reducing expenditure appears to be the most realistic option. To achieve this, GPs must consider collaborative arrangements with other practices, as a federation, a super practice or a similar alternative delivery structure. This will enable them to achieve scale to cut costs in areas such as practice management, back office functions, accountancy, preparation for regulatory inspections, clinical negligence insurance and locum GP costs

• The main option available to increase income is to bid for CCG-led contracts to provide acute services which were previously under the auspices of local NHS trusts. However, this will require careful consideration of the structural form and skills needed to bid for, and deliver, such contracts

• At the individual practitioner level, GPs may look to increase personal earnings by creating new, larger practices with their peers. This arrangement will enable them to cover additional sessions at other linked surgeries to avoid the costs of hiring a locum GP. It may also have the added benefit of improving work-life balance by removing some of the pressures associated with managing a smaller practice, as well as increasing resilience within the service. Issues related with this concept are the need for such partnerships to think carefully about

reward structures within the new organisations, ensuring individual surgeries within the organisation are fairly remunerated to reflect the amount of business they bring. One option for achieving this would be the use of individual profit centres for member surgeries

• In some areas GPs also have the option of working for a local NHS trust as a salaried GP. This has two clear benefits. First, it reduces their exposure to financial risk and removes the administrative burden of sole or small practices. Second, it enables trusts to manage patient pathways more effectively

• It is in the long-term interest of CCGs to assist GPs in their area in moving towards delivery of primary care at scale. If the crisis in primary care is not resolved, secondary healthcare budgets are likely to continue to overspend in turn

Primary concern Shaping the future direction of primary care 1

Recommendations from the round table

• Practitioners should initiate discussions around collaboration with other practitioners, NHS trusts, CCGs and other groups within the wider health economy and external partners before their individual primary care businesses reach crisis point

• CCGs should facilitate discussions and promote initiatives to strengthen the sustainability of primary care within the local health economy. This should involve facilitating access to expert legal and financial advice for primary care providers that want to move towards a model that provides primary care at scale

• Practitioners should explore new ways of working across existing practice boundaries, including traditional boundaries with the secondary care sector

• CCGs should actively promote innovation among primary care clinicians, including how radical redesign of service delivery can be achieved

• Practitioners and CCGs should explore options for moving away from traditional, surgery-based models of delivery to make full use of digital developments where possible

• Practitioners and CCGs should seek widespread engagement to address the challenges in primary care, obtaining the buy-in from all stakeholders

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2 Primary concern Shaping the future direction of primary care

Executive summary

Pressures on primary care are coming from all directions

PMS contract reviews

Pension changes

GP shortages

CQC inspections

Insurance costs

GP locum costs

Patient demand

GP retirement plans

Traditional GP partnership

Background

According to a recent BMA survey, “46% of practices report that they have GPs who are planning to retire or leave the NHS”. Many older GPs, beset by surges in demand and the resulting financial pressures, are seeing proposed caps to the pension as a strong incentive to leave the profession. Wary of the financial and administrative burden faced by their predecessors, younger doctors increasingly opt for the flexibility of working as a locum or in specialist urban centres of excellence.

Following heightened public interest, the demands, both financial and temporal, placed on practitioners to comply with external scrutiny serve to further exacerbate the issue by squeezing practice finances and presenting an increasingly less appealing picture of the profession to younger prospective partners. Practitioners cite the spiralling costs of recruiting locums as cover as a major issue, with some stating that the cost has even prevented them from being able to take time off.

Add to this the uncertainty surrounding new NHS contracts for junior doctors, the impact of potential competition from alternative service providers and the future public health issues associated with an increasingly aging population. The end result is a financial and recruitment crisis across general practice.

“Wary of the financial and administrative burden faced by their predecessors, younger doctors increasingly opt for the flexibility of working as a locum or in specialist urban centres of excellence.”


“A GP workforce crisis is emerging. Not enough GPs are being trained, more trainees work part-time, and more existing GPs plan to retire early. Numbers are not keeping up with hospital doctors.”Source: ‘Is General Practice in crisis?’, Nuffield Trust, November 2014

“We all accept that we have a long way to go to hit the ambitious recruitment targets set for primary care, but we must use every effort to try, as this will be necessary for much of the reform required.”Source: ‘General Practice Forward View’, NHS England, April 2016

“Between 2003 and 2013, the number of hospital consultants increased by 48% while GP numbers increased by only 14%. Indeed, the number of GPs per head of population has declined since 2009, with major problems of recruitment and retention.”Source: ‘The future of primary care’, Health Education England, 2015

Around 22% of GPs in London could step back from front line

patient care within the next 5 years (with 41% of London GPs

being over 50)

40% of medical graduates are choosing to enter general practice

training – as opposed to training for other specialties – despite a national target to ensure that 50% of medical

graduates go into general practice

With a growing and ageing population, in which increasing

numbers of people have multiple long-term conditions,

the GP workforce needs 8,000 more FTEs by 2020

More than 1,000 GPs will be leaving the profession on an annual basis by 2022

More than 500 practices are under threat of closure, because so many doctors are close to retirement age, with too few younger medics stepping in to replace them

The number of unfilled GP posts has nearly quadrupled in recent years (from 2.1% in

2010 to 7.9% in 2013)

Source: Royal College of General Practitioners – Oct 2014


Background

The system, already creaking under the weight of current service levels, looks set to miss out on a new generation of medical talent unless radical changes can be made to the way the service is delivered. General practice in the UK is facing up to a perfect storm of increasingly unsustainable demands for its services, a recruitment crisis and ever more pressing financial concerns.

Despite this, the general view at the round table was that simply increasing funding will not solve the problem. The NHS appears to have reached a ‘tipping point’ beyond which traditional models of service delivery are simply no longer sustainable.

Single practitioners are thought to be closer to this ‘tipping point’ as they are considered to be most at risk from the twin spectres of financial pressures and external inspections. Despite this view they are held in high regard by the public, as evidenced by their generally stronger customer satisfaction.

“Single-handed practices achieve high patient satisfaction scores, compared with group practices, which supports the view of single-handed practitioners that they are better able to provide both a personal service and an efficient service based on continuity of contact and knowledge of individual patients.”Source: ‘General Practitioners at the Deep End’, University of Glasgow, May 2010

The difference between the reality of managing financial and patient risk in comparison to public perception and desired care levels represents the crux of the matter. GPs want to deliver the quality and continuity of service associated with single practitioners. Yet the demands for efficiency placed on them within the NHS and the unrealistic expectations of consumers render this impossible.

Fortunately, there are a number of options for alternative delivery available to service providers (which we provide details and case studies of later in this report). These options centre around increasing efficiency within the primary care system while maintaining the same personal feel and high standards of care experienced by users of smaller sites. There are two key strands to this: 1 Collaboration between practices, enabling some of

the administrative and financial burden to be removed from GPs through achievement of greater efficiencies, economies of scale and effective practice management, relieving the requirement for GPs to act as small business owners as well as medical practitioners

2 A fundamental redesign of the patient experience, rethinking and increasing the skills mix available at practices and the ways patients access services


Background

While GP federations have been in existence for some years now, the creation of super practices appears to be bearing some fruit (as evidenced by recent events in Birmingham). In our view, these organisations provide greater resilience from:• a financial standpoint – sharing the burden of increased

locum and premises costs among a greater number of practices and achieving savings through bulk purchasing

• an operational standpoint – ensuring practitioners are able to take time off, safe in the knowledge that a larger group of colleagues will be more likely to have the spare capacity required to provide cover.

Our discussions, with a diverse range of sector professionals, indicate that this is an attractive prospect, although they note that the ability to build an atmosphere of trust among groups of practitioners, and effective practice management, are vital to their success.

According to the CQC, in 2014/15, "the average size of an 'outstanding' practice was seven or eight GPs. The average size of an inadequate practice was three or four … In 2016, around three-fifths of GP practices have fewer than four partners. Only six percent have 10 or more."

In some ways, this line of thinking is concurrent with our own findings from discussions with healthcare professionals. There appears to be a broad consensus that the administrative burdens of dealing with the regulatory and business pressures faced by many GP practices was one of the key drivers behind the reluctance of many younger practitioners to take on a partnership in an existing practice. At the round table we heard anecdotal evidence of practitioners unable to take annual leave due to the cost and difficulty involved in hiring a locum to stand in. Similarly, it was felt that increasing focus on safety requirements from regulators could also hasten the demise of many single practitioners. In the face of this, many felt resigned to the idea that the future of the service lay in the 'safety in numbers' of larger practices.

Somewhat paradoxically, our discussions at the round table also indicate that, despite the CQC's findings, anecdotally both patients and practitioners report greater levels of satisfaction with 'smaller' practices with two or three practitioners as opposed to the larger practices. This seems to be related to the more personalised service and stronger interpersonal relationships practitioners and patients are able to build in these circumstances. One thing is clear; while reforms may be necessary, it will also be important for practitioners not to lose sight of the importance of doctor-patient relationship in the minds of service users.

Our Health PartnershipOur Health is the first super-partnership in the UK, which brings together 32 practices and 150 GP partners, serving around 276,000 patients in Birmingham, Walsall and Sutton Coldfield.

The partnership’s aims are to make life better for patients and practitioners alike, while improving the resilience, efficiency and quality of their member practices, and looking forward they see even more integration with health and social care professionals in hospitals, local councils, national charities and the voluntary sector.

In a nutshell, by being part of Our Health Partnership we will:• work more closely with social services and other

community care services to keep people out of hospital and treated closer to home

• make sure our patients come first

• stop our practices being taken over by private companies or hospitals, as is happening elsewhere in the country

• reduce the risk of your practice closing, as is happening elsewhere.

Source: Our Health Partnership website

Case study

Collaboration


Effective practice management will be key. Collaboration between practices should enable them to utilise the increased purchasing power and efficiencies of scale that come with operating as a larger, private company structure (or similar). In addition, working more effectively with a range of professional service providers will enable practitioners to relieve themselves of the stress of running a small business and focus on their primary vocation; patient care. Furthermore, delivery of the service at scale should also enable larger practices to recruit a higher calibre of practice manager and support staff, as evidenced by the experience of Our Health Partnership. Delivery of the service at scale also gives organisations the opportunity to make great savings across the board. This includes everything from back office and accounting costs through to their increased ability to procure assistance in preparing for inspections, clinical negligence insurance and locum GP costs.

The creation of large super practices is the most ambitious and most rewarding route for individual practices to improve their profitability and achieve big savings. There are other options. In other cases, practices have been able to make more modest savings through looser collaboration initiatives, such as a GP federation.

The ability to recruit a superior team will assist the new organisations in navigating the minefield of ensuring their reward structures adequately reflect the value each practice adds on an individual level. One possibility is to set up each practice as a separate profit centre, with the added advantage that this will encourage a greater focus on costs at a surgery level. With the greater economies of scale available to larger practices, obtaining the kind of detailed analysis and financial reporting capabilities required to achieve this and reap the available rewards will be a more realistic prospect. Despite the large size of some super practices or federations, this model will enable the service to safeguard its future without compromising the strong commitment to building and maintaining service user relationships which is so important to healthcare professionals.

Suffolk GP FederationThe Suffolk GP Federation is a not-for-profit federation of 59 independent GP practices covering 540,000 patients. Member organisations remain independent, but collaborate in developing strategy for local primary care.

Member GPs consider the large number of small providers in the industry to be a weakness, which can be overcome by joined-up working. The federation can gain a management infrastructure, skills and expertise that an individual practice would find uneconomic to employ, meaning that together, practices can address issues and hurdles, share best practice and overcome cost barriers (such as bidding for contracts) that would be prohibitive for a single practice.

Case study

Wolverhampton vertical integrationIn Wolverhampton, the Royal Wolverhampton NHS Trust is working with three GP practices on a ‘vertical integration’ pilot, with assistance from NHS Wolverhampton CCG and NHS England.

Vertical integration is a model of care commonly used elsewhere in the world (eg USA, Spain), where primary and secondary care practitioners are part of a single organisation and work together.

The move towards integration will remove the need for some of the processes currently in place to organise patient care between different organisations, meaning that the system can be made more streamlined and efficient, providing better value for money for the taxpayer.

Case study


Collaboration

Redesigning the service user experience

Innovative ways to relieve pressure upon practices are being considered by many GP practices. Chief among these is the option to increase the use of healthcare assistants

There appears to be a prevailing sentiment among practitioners that many visitors to primary care do not require the services of a GP and, that with sufficient training, healthcare assistants could do more. Other suggestions include the use of telephone or online triage to reduce visits to the premises, and the use of mobile practitioners, especially in remote areas. However, innovations such as these will require a fundamental change in the relationship the public has with the primary care service. As observed by one sector professional, “the hardest union to negotiate with is the public – they’ll never give up on bricks and mortar”. Even within existing surgeries, it was felt there were plenty of opportunities for better deployment of healthcare assistants and other existing staff to free up GP time.

“Practitioners must look at their skill mix. It all needs moving down the scale; most people in primary care don’t need to see a GP – up-skilling healthcare assistants is vital.”Round table participant

There was also the general belief that improving the patient experience shouldn’t just be limited to GP practices and that commissioners and providers of acute services also had a key role to play. Dudley’s single patient portal was cited as an example of what may be achieved when providers and commissioners at both secondary and primary healthcare levels take a joined-up approach to service provision.

“The benefit for the patient is that if GPs do truly become multispecialty community providers then it brings quality and consistency to health. For GPs it will bring in additional income streams, so there are benefits all round.”Round table participant

Dudley single patient portalOver the next few years, Dudley CCG is focusing on a model of care based on a network of GP-led, community-based multi-disciplinary teams which enable staff from health, social care and the voluntary sector to work better together, as part of a multi-specialty community provider.

The CCG is aiming to create a local public service for Dudley people that will improve their ease of access to care, enable appropriate advice and guidance and connect this with the ability to book appointments. They are designing a ‘single patient portal’, scheduled to go live from April 2017, which will include NHS 111, telecare, emergency social care services, the community mental health hub and GP out-of-hours services. The centre will have a single number for the public to use, and will utilise down-time to make proactive calls to patients (such as appointment or vaccination reminders and telecare alerts).

Case study


As a response to the widespread financial turmoil within the NHS, many local health economies are looking at fundamental redesigns of acute provision, with some services such as critical care being centralised, leading to a scaling down of provision at other centres. This will inevitably have a subsequent effect on primary healthcare providers, which may see an increase in demand from patients who may previously have used their local accident and emergency (A&E) unit. Similarly, A&E providers themselves have repeatedly expressed concern at being stretched to capacity by having to deal with patients whose needs may be best served elsewhere. This new approach to the delivery of acute services will also provide some GPs with the option to work directly for local trusts as salaried staff, a move which will provide more security and stability for practitioners who are reluctant to take on the pressure and uncertainty of running a small business.

The round table also considered the use of a ‘single point of contact’ for healthcare queries, with the aim of more effectively directing and advising the public and reducing strain on services. The round table concluded that closer working with care homes and acute hospitals, as well as with fellow GPs, were all initiatives that would enhance the patient experience and should be welcomed.

Strongly linked to proposed new services – such as Dudley’s single patient portal – is the idea that the primary healthcare service must better exploit twenty-first century technology in order to thrive.

Despite the ubiquity of broadband and mobile internet devices in workplaces and social spaces across the UK, research from the think tank Reform suggests that only seven percent of service users have booked an appointment online. Traditional ideas such as having to arrange to visit your GP practice by telephone and then have appointments in person are being challenged. Similarly, technology is being used for GPs to assess patients remotely without the need for a home visit or for the patient to visit the surgery in some cases.

Our intelligence from within the healthcare professions suggests that practitioners see the reshaping of this model as fundamental to future efficiencies. Another Midlands super practice, Modality, has taken an innovative approach to solving the problem of providing a service outside of traditional office hours (see case study for detail).

Advances such as the use of instant messenger or tele-conference services to speak to healthcare professionals in place of appointments for more routine queries are exactly the kind of development which service providers need to consider. Other possibilities mentioned by healthcare insiders we spoke to included the improvement of existing telephone triage services in order to direct service users better. Ultimately, the increased scale of collaborative practices will enable them to invest in new technology as it becomes available; the possibilities are endless.

Corby Urgent Care CentreThe Corby Urgent Care Centre is provided in partnership between NHS Corby CCG, Lakeside Plus, Lakeside Surgery and Corby Borough Council. It is open from 8am to 8pm, 365 days a year and aims to assess 95% of patients within 15 minutes, without appointment.

The service is an alternative to A&E and offers help with urgent injuries such as fractures, sprains and burns etc. The aim is for the centre to provide care closer to home, rather than patients having to travel to Kettering Hospital, and to avoid unnecessary hospital admissions.

The Urgent Care Centre has had a noticeable impact since its inception. Within the first eight months of operation (2012/13), A&E attendances fell by 51%, adult 24-hour admissions by 27%, paediatric 24-hour admissions by 14% and there were savings of £685 thousand per year.

Case study



Modality PartnershipThe Modality Partnership is a GP super-partnership that operates across 13 different locations in Sandwell and Birmingham. As an organisation, Modality aims to combine the advantages of small practices working closely in local communities with the medical and technological opportunities that come from being part of something bigger.

Since 2014, Modality has been in partnership with digital healthcare company Digital Life Sciences. Together, they won funding from the Prime Minister’s Challenge Fund in order to undertake a digital healthcare pilot.

Together, they are creating an online service, making it possible for patients to communicate with GPs and nurses via Skype or instant messaging, with the ultimate goal being to enable patients to access healthcare from 8am to 8pm, seven days a week.

Running parallel to the theme of technological advances in service delivery is rethinking the locality of practices. Some secondary healthcare providers, such as South Warwickshire Foundation Trust, have experimented with the concept of ‘virtual wards’. In a virtual ward, a team of nurses work closely with a patient’s GP and other health and social care professionals, with the aim of helping the individual to self-care. Successfully delivered, this can reduce the need for unplanned hospital admissions or visits to the GP. Many of the healthcare insiders who we spoke to felt that this idea could be expanded to include mobile practitioners for certain services.

Winning over the hearts and minds of existing service users who may be resistant to change will not be straightforward though. Practices will need to be proactive and creative in engaging with stakeholders and clearly broadcasting the benefits of these proposed new arrangements.

Case study



Barriers to progress

“An alternative model of healthcare is inevitable ... whatever model of healthcare comes forward, primary healthcare will have a key role, and we need to be better organised to do it.”Round table participant

Our roundtable discussions identified several potential barriers to progress. The principal one was the need for a sea change in attitude among practitioners, particularly where the belief persists within some practices that they can ‘scrape by’ as they are. Given the pressure GPs are under, a reluctance to take on the additional challenge of taking part in such fundamental changes to the service is perhaps understandable. However, healthcare professionals we spoke to suggested that all GPs would need to buy into the ideas behind the required reforms in order to move things forward. Fear of going out of business was starting to be a driver for change for some GPs.

“My first question was; ‘where is your development programme for practice managers of the future?’. Unless you start now developing these people, you’re going to be in a situation where you’re hiring managers who do not have the knowledge and experience to do the job.”

“The issue is getting GP buy-in. Most of what has happened so far has been motivated by fear.”Round table participants

Inadequate investment in practice management was another critical barrier to change. The skills required to manage a large chain of surgeries, or to operate federation companies in future would be different to those previously needed to run much smaller practices operating out of a small number of surgeries. In some cases, where particular practice managers had specific strengths in book keeping, managing people or preparing for CQC inspections, these strengths could be made available to a wider group of practices.

Where GP-led companies were bidding for large contracts against NHS trusts, the companies required strong contracting and negotiation skills. Practice managers would need to gain access to new business skills to drive the businesses forward.

Adequate communication and the role played by CCGs are central to change. As commissioners, CCGs are the common link between all providers and are a crucial cog in the local healthcare economy themselves. CCGs will need to facilitate a dialogue between primary care providers in their area, and between primary and secondary care, if there is to be successful change.

The incentives for change also need to be clearer. GPs need incentives and

improvements to morale in order to sufficiently energise the service to take on the challenge of reform. The current uncertainties around the proposed new contract for GPs is a key factor in reluctance to make concrete plans or consider serious upheaval among some practitioners. The impact of this, when details become known, will be a major influence on the ability of the NHS to implement the changes required for the long-term stability of primary healthcare.

Finally, many practitioners are worried that changes might leave them exposed to greater risk. Any move towards alternative delivery models such as different partnership or company structures needs to be taken cautiously, and with the benefit of proper professional advice. In some areas, GPs had already invested money in a federation, with little additional business or other financial benefit to show for it. At our round table, there was a feeling that some federations had been set up without necessarily thinking of what they wanted to achieve.

The increased ability of larger, more resilient practices to procure a higher calibre of professional advice in this field will be vital to enabling practices to navigate the move to a more sustainable, collaborative model.


The recent publication on the NHS Forward View for primary care is an encouraging recognition from NHS England as to the scale and pace of some of the changes that are required.

General Practice Forward View

The General Practice Forward View was published in partnership with the Royal College of General Practitioners and Health Education England. It covers five areas: overall investment, workforce, workload, infrastructure and care redesign.

The overall investment will see recurrent funding increase by an estimated £2.4 billion a year by 2020/21. This increases the share of spend on general practice services to over 10% of overall English NHS spending. A package has been developed with a further £500 million to support struggling practices, develop the workforce, stimulate care redesign and tackle workload. NHS England and the BMA are considering ways to better and more equally reward practices for their workloads based on their specific practice population demographics.

On workforce there is a plan to double the growth rate of GPs through new incentives for training, recruitment, retention and return to practice. The objective is to add a further net 5,000 GPs in the next five years. They also aim for 3,000 new practice-based mental health therapists, 1,500 co-funded practice clinical pharmacists and nationally funded support for practice nurses, physician assistants, practice managers and receptionists. There will be more support for GPs’ personal resilience, focusing on burnout and mental health issues via a new free occupational health service.

A further £40 million will be invested into a practice resilience programme (£16 million in 2016/17) to assist in managing workload with the possibility of establishing teams to go in to work directly in practices. This will support struggling practices, see changes to streamline the Care Quality Commission inspection regime, help GPs suffering from burnout and stress, cuts in red tape, legal limits on administrative burdens at the hospital/GP interface and action to cut demand on general practice.

New rules on infrastructure will allow up to 100% reimbursement of premises developments, direct practice investment in technology to support better online tools and appointment, consultation and workload management systems and better record sharing to support team work across practices. There will be development of IT services for 2017/18 including: funding for practice WiFi; access to planning and analysis data tools; guidelines on e-procurement; and support for patients to use online services.

To assist care redesign there will also be support for individual practices and for federations and super partnerships; direct funding for improved in hours and out-of-hours access, including clinical hubs and reformed urgent care; and a new voluntary contract supporting integrated primary and community health services. There is a major programme of improvement to support, strengthen and redesign general practice. New funding of up to £500 million annually by 2020/21 aims to allow locally-determined evening and weekend access. A new Multispecialty Community Provider (MCP) contract will be voluntarily available to support new clinical and business models for integrated provision of primary and community services.

The Forward View has been well received as an important first step in recognising and starting to tackle the serious issues in primary care. However, some GPs have commented that it has failed to tackle the issue of the rising costs of medical indemnity insurance which has been blamed for many GPs wanting to leave the profession. We feel that the direction of travel set out in the Forward View complements the key issues raised in this paper. It is clear in its support for encouraging primary care to be delivered in new ways and in promoting the use of modern technology and a different skill mix in primary care.


Barriers to progress

Conclusion

“I don’t see any solution to the problems in the health system coming from throwing more money at it – we’ve got to do everything more effectively.”Round table participant

We currently stand at a crossroads. Decisions taken at this point will have a significant, long-lasting impact on the future of the delivery of primary healthcare within the UK. The message from our round table participants is clear; providers cannot afford to stand still. That the current model is unsustainable is not in dispute. All practitioners must now accept the scale of the issues at hand and take an active role in the development of new organisations delivering primary care at scale. Practitioners must work collaboratively with each other, the wider healthcare economy and their service users in order to generate original, creative ways to deliver their services. In addition, they need to seek out new partners to work with and new technologies to exploit and, in doing so, breathe new life into this vital service.

In our view, it is also in the interests of CCGs to take an active role in facilitating and supporting these collaborative efforts. Our case studies provide encouraging signs that innovative redesign in primary healthcare services can have a real positive impact on the number of unnecessary hospital admissions or A&E visits in an area. Simply put, without a significant improvement in primary healthcare delivery, secondary healthcare budgets will continue to overspend.

Summary of options for GP primary care businesses

Stay as you are – but innovate

GP provider company to tender for more business

Form a super-partnership

Take-over by acute trust

Federation to reduce back-office costs

Multiple smaller partnerships/mergers

Join an existing super-partnership

“The message from our round table participants is clear; providers cannot afford to stand still.”


Round table participants

Andy HadleySenior Primary Care Development Manager (Tamworth locality)NHS South East Staffordshire and Seisdon Peninsula ClinicalCommissioning Group

David RowleyExecutive Grant Thornton UK LLP

David WigleyLay Member NHS South Worcestershire Clinical Commissioning Group

Dr Helen HibbsChief Officer NHS Wolverhampton Clinical Commissioning Group

James CookHealthcare Commissioning Lead Grant Thornton UK LLP

Keith TimmisLay Member – Governance & Audit NHS Shropshire Clinical Commissioning Group

Laurelin GriffithsExecutive Grant Thornton UK LLP

Mark FordAudit Committee Chair NHS Solihull Clinical Commissioning Group

Martin RamseyProfessional Partnerships Director Grant Thornton UK LLP

Terry TobinSenior Manager Grant Thornton UK LLP

Tony HadfieldChair & Lead for Governance, Audit & Remuneration NHS Redditch and Bromsgrove Clinical Commissioning Group


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Contact us

If you are a GP interested in the points raised in this publication, please contact your local Grant Thornton representative or one of our specialist team:

If you are a CCG, please contact a member of our public sector team:

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Shaping the future direction · up to a perfect storm of increasingly unsustainable demands for its...

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Transcript of Shaping the future direction · up to a perfect storm of increasingly unsustainable demands for its...