The Rise of the Super Practice

When first hearing the term, you may be forgiven for imagining a giant underground lair hosting some of Marvel or DC Comic’s finest. Judge Dredd being a favourite of mine since I was a young teenager explains a lot.

There are masks (albeit surgical), daily battles to fight, good and evil – and we could even throw in a villain or two for good measure. At this point, I am going to use a random name, Jeremy Hunt, as it is a typically sounding, clean-cut, Bond-esque villain type name. And not because most people working in the NHS may have heard of a chap who goes by the same name. But do feel free to insert a name of your own but remember if it’s one of your line managers, don’t repeat it in their presence.

But Super Practices are coming our way. Maybe we will have a new name soon but the term is being bandied around more than election manifestos. As I am sure many of you know, Super Practices are part of an effort by (the current – political balance) government to:

  • Improve the resilience of GP practices
  • Improve access to GPs for more hours a week
  • To ensure GP practices, partner and staff have something of a lifeline to allow them to keep their heads above water.

The current language is more of resilience and clustering, however. Those terms sound much more nurturing, helpful, less scary and much less ‘Hooded Claw’ than a Super Practice. It also offers greater self-determination than something that is mandated on practices. So, resilience and clustering (was that a 1980’s US cop series or is that just me?) is all about supporting and encouraging GP practices to work together, encouraging them to share resources, staff and services. And to pool their expertise and contribute with peers on shouldering responsibility for things like urgent care and extended access. Without the mandated-ness.

There are well trailed signs that far from being a scary, giant underground lair, the Super Practice is a preferred way forward. Maybe even supported by incentives to move in that direction. And all part of the latest thoughts to help implement the “Five Year Plan”. (Given my description at the start of this blog, I am now wondering if the NHS Forward View has actually been penned by someone, somewhere with a childhood rooted in comics of the Marvel/DC type as that now sounds quite sinister). The main trailing has been around 7,500 practices becoming 1,500 clusters / Super Practice, each delivering care for populations of around 40,000-50,000 patients. All sharing resources and expertise to give them a little more scale.

There remains some additional thinking to do about how that fits into the Federation/ACO model and how competitive issues will be resolved in tightening local circumstances. But these are matters of detail we will all no doubt come to work out between us.

Are Super Practices the solution to primary care?

Whilst most would welcome the efficiency that could be created by collaboration and the improvements in patient care that could result, there are a lot of unanswered questions around Super Practices. Not least the, dare I say, possible resistance from some practices keen to retain their own identify. But possibly from the wider healthcare community and from patients. There are key issues that need to be addressed to enable it to happen commercially. That aspect could be a blog in it’s own right so I will keep this relatively brief. Why would a GP contract holder want to give up their independence? How could such a move be mandated? Would this require issues we see in the commercial field to be addressed such as contract buy outs, possibly underpinned by legislation and regulation change? Is there an appetite for such changes?

Who can tell where the dust will settle after the election on a whole range of issues. But given NHS England has an existing mandate to ensure half of the country is covered by the new care models by 2020, how will some of the following issues be tackled? What were the lessons learned from delays in implementing the new pilot contracts for multi-speciality community providers (MCP)? How will the GPC’s fighting for practices to keep the GMS contract alongside the new contract play into the creation of Super Practices? And probably one of the bigger issues, how will future arrangements fit with STP local agendas and be clearly linked to outcomes such as reductions in hospital admissions?

And that is a mere tip of an iceberg on the questions front.

Reaction from GPs and Patients

There does appear to be more than a little initial resistance to the plans. Hardly surprising as there has been little real ‘warming up’ of practices over the last few months. Something about Europe I think… A recent GP online poll shows that four out of five GPs believe the government’s vision of primary care migrating from the current system to 1,500 Super Practices would undermine general practice. Not a shock there but it indicates there is a long way to go. Using the resilience and clustering route as a way to start local conversations between practices is probably not a bad thing. “Look how challenging the future will be” is always a great way to start bringing people together to defend against the unknown. Seemed to work every time The Hulk was spotted in the area. The local townsfolk always seemed to have a handy US Army unit nearby ready to defend the town.

And using resilience and clustering as a starting point will deliver clear benefits to practices anyway. Efficiencies through shared resources, improved access to GPs at evenings and weekends. Maybe learning to live with the foibles of others and to work co-operatively with one another? And certainly, sharing access to other services such as community nursing, mental health and clinical pharmacy teams and pooling responsibility for urgent care and extended access.

Some patients may have to travel longer distances to access these services which could be an issue. And as Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, recently pointed out, many patients value the connection that they have with their local GP. Are these GP and patient relationships sustainable at Super Practices serving a population of around 40,000? No particular reason why not but there will be likely be less of that one-to-one contact in future.

The Rise of the Super Practice

Probably one of the films you missed recently. It was not a major box office hit and most members of the public did not notice it being released. Some great characters in the film. Some heroes and some anti-heroes. And some hero’s Aunties. The plot line was initially a little thin but it started to pick up and it seemed to accelerate towards the end. I seem to recall it was based in a world where there was a rising, ageing population who had multiple and sometimes complex long term conditions. There was a series of towers where the main planners lived and they predicted that change was needed. To be honest, I cannot recall how it ended up but I do recall a lot of soul searching and fighting in the middle portion. Seemed to work out OK for some though.

Only time will tell if Super Practices are the future or just another idea that came and went. But importantly both the new government and the whole healthcare community must start the journey and engage to achieve a solution.

Rachel Edwards is Partner at Libre Advisory