RCGP-Nuffield General Practice At-Scale Programme Dr Mike Holmes, RCGP Clinical Lead Dr Rebecca Rosen, Senior Clinical Fellow, Nuffield Trust #GPatScale

Drivers of at-scale collaboration Reduced funding Large scale general practice organisation Reduced funding New funding for large scale GP providers (eg GP Access Fund) Threat from alternative GP contracts Threat from alternative GP contracts CCG prime and alliance contracts Rising patient demand Rising patient demand Rising administrative demands New contracts for extended services Push factors Historic relationship between practices Pull factors Rising administrative / regulatory demands Alternative GP contracts Policy on extended and seven day access Local history and context: GP Fundholding Practice-based commissioning Delivering community services Policy on extended and seven day access Potential funding for large scale GP providers via STPs Workforce shortages Workforce shortages #GPatScale

Large-scale brings opportunities Staff were broadly positive about working in a large-scale organisation They valued education and training opportunities and peer support arrangements across practice boundaries Larger scale can improve sustainability through operational efficiency, technology and enhancing the workforce But significant resources are needed to develop and maintain new initiatives Patients had mixed views about large-scale general practice They identified more with their own practice than with the overarching organisation and worried about losing continuity Source: Rosen et al 2016 Is Bigger Better: Lessons for Large Scale General Practice 

Understand GP collaborations Our support offer RCGP-Nuffield General Practice At-Scale Network aims to: Survey RCGP (2015 and 2017) Examine case studies of success Understand GP collaborations Consolidate evidence Facilitate expert advice Support practices

GP At Scale Programme

What Next?

We want to hear from you What are your experiences of working at scale? How can we best support you? What else can we do to facilitate this agenda? How can we grow the network?

Thank you