Throughout August we’ve run a series of blogs where Ben has considered various aspects of the independence of general practice. In this fifth and final blog in the series he asks

Is operating at scale necessary to protect the independence of general practice?

There is something counter-intuitive about the notion that practices would operate at scale to protect their independence. Many GPs resist any notion of operating at scale precisely because of the restrictions they feel it places on their autonomy. The perceived wisdom is at-scale general practice is a step away from independence, not a move towards it.

But is it? I was struck by the tale of the practices in Wolverhampton. Recently a ninth local practice has handed over its list to the local hospital trust there, taking the total population now under the hospital’s control to 70,000. Now, I am not close to what is happening in Wolverhampton but local GP leaders said the GP partners were motivated by financial ‘non-viability’ and workforce shortages, with the move viewed as ‘handing over the problem to someone else’.

One of the practices put this on its website as it announced it was joining the hospital, “Without the help of The Trust we would definitely have left and would have had no option but to close the practice and split our list up amongst other local Practices. The Trust have been able to find us new Partner GPs, a new site and the funding to refurbish it into a modern GP Practice.”  The local practices, it seems, felt like there was no alternative.

I am sure everyone reading this is aware of the pressures currently facing general practice. Those pressures are not going away. There are no new GPs. Demand is continuing to rise. The financial pressures remain significant. At some point, almost inevitably, practices (like those in Wolverhampton) will reach the point where they decide to hand over the pressure of running the practice, to let someone else take on the responsibility, and to simply focus on the patients in front of them.

In a period of sustained pressure on general practice, where salaried doctors are increasingly earning more than the GP partners, more and more practices will reach this ‘enough is enough’ point. And if the local hospital, or community trust, or whoever, offers to take on the responsibility, increasingly practices will make the decision to trade their independence for the relative security and simplicity of salaried life.

If we take the practices in Wolverhampton back 3 or 4 years, would they have made the same decision then? Could they have envisaged then that things would get to the point where this was the choice they would make? And if they had known this would happen would they have chosen to do things differently?

But what could they have done? Well, the opportunity that practices working together (“operating at scale”) presents is for practices to support each other, and to work together to tackle the workforce, demand and financial pressures all are experiencing.

Here is the irony: practices resist operating at scale in the name of keeping their autonomy, but by doing so are keeping themselves on a track that is taking them to the ‘enough is enough’ point when they will hand their list over to whoever will take it. The status quo is unlikely to remain an option for much longer. However counter-intuitive it feels, it is choosing to work together with other practices that is most likely to protect the independence of general practice.