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Mike Holmes is a GP in a large practice of 50,000 patients in York & Hull and part of a GP Federation covering 130,000. He is also the newly elected Vice-Chair, Membership of the RCGP. Furthermore Mike is a founder member of NHS Collaborate, the primary care leaders’ network developed by primary care leaders. In this episode Mike tells the story of how his practice grew across two cities, how the large GP federation emerged and what at-scale general practice has been able to deliver in York and Hull. In telling his story he outlines some important lessons about GP resilience and how it can be strengthened by increased scale.

Show Notes

Mike begins his story (1min 02secs)

Mike’s practice in York begins to expand (2min 07secs)

A conscious decision to increase scale and appoint some non-clinical leadership (3min 18secs)

The Equitable Access to General Practice programme – expanding to Hull (3mins 51secs)

Remodelling the workforce – beginning with community pharmacy (5mins 33secs)

The impact of difficult GP recruitment (6mins 33secs)

Does size create resilience? (8mins 08secs)

Doesn’t increased size just bring increased problems? (9mins 22secs)

Routine 15 minute patient contacts (11mins 02secs)

Measuring quality (11mins 48secs)

QI Ready with the RCGP (13mins 53secs)

Three elements to resilience including pragmatic optimism (14mins 43secs)

Support for innovation (16mins 27secs)

Nimbus Care – an alliance of practices creating Communities of Care (17mins 24secs)

Engaging all stakeholders (19mins 59secs)

Why such scale? (20mins 56secs)

Collaboration increases sustainability (22mins 55secs)

Connecting, listening, recognising vulnerability and risk taking (24mins 15secs)

The two previous episodes in this series with members of NHS Collaborate can be found at: Episode 87 – Jonathan Serjeant on Generative Listening and Episode 91 – Mark Spencer on Risk Taking

The NHS Collaborate website can be found here

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Suffolk GP Federation is a not-for-profit organisation owned by 58 GP practices and established in 2013. They deliver a number of services including cardiology and ultrasound and Suffolk GP+, which provides extra doctors’ appointments during extended hours. In this episode Ben talks to Chair and Medical Director Paul Driscoll and Chief Executive David Pannell. They explain what the federation does and how it works and look to the future with a super-partnership and a potential role in becoming the voice of general practice locally.

Show Notes

Paul, then David, introduce themselves and explain the main problems in Suffolk (53secs)

Where the federation came from (1min 44secs)

How the federation is funded (2min 28secs)

What the federation offered to the practices (3mins 09secs)

The roles of the federation (3mins 41secs)

Funding the management team (4mins 49secs)

350 staff and a turnover of £18m (5mins 09secs)

A community interest company (5mins 35secs)

Funding the work of the federation (5mins 49secs)

Defining success (6mins 44secs)

Engaging with the member practices (7mins 42secs)

The federation Board (8mins 30secs)

How do the practices view the federation? (8mins 51secs)

The direct provision of general practice (9mins 16secs)

Capital requirements not huge (10mins 25secs)

Using directly managed practices as a “test bed” (10mins 56secs)

Progress towards a super-partnership (12mins 18secs)

How does the model work? (13mins 29secs)

How do the federation and super-partnership interact (14mins 22secs)

Engagement in accountable care (14mins 47secs)

Representing general practice (15mins 40secs)

What have they learnt from the journey? (17mins 30secs)

A voice for general practice in the future? (19mins)

What next? (19mins 59secs)

Finding out more (20mins 59secs)

David can be contacted via david.pannell@suffolkfed.org.uk and their website is here

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Martin Ramsey is an accountant with MHA Macintyre Hudson, a firm of chartered accountants, tax and business advisers with a large presence in primary care. Martin has been involved in the development of Our Health Partnership (OHP), the Birmingham based super-practice whose progress we have been following on the General Practice Podcast. In this episode Martin talks about the process of establishing super-partnerships including the opportunities, the risks and the challenges.

Show Notes

Who are MHA Macintyre Hudson and what do they do (43secs)

Martin’s involvement in OHP (1min 17secs)

Merger and super-practice; the dividing line (1min 45secs)

The models of merger (2mins 49secs)

Who is the OHP model best for? (3mins 53secs)

The opportunities and challenges of super-partnerships (4mins 48secs)

The impact on staffing (5mins 55secs)

Reducing accountancy costs (6mins 54secs)

The risks of joining a super-partnerships (7mins 54secs)

Joint and several liability (8mins 48secs)

Mitigating those risks (9mins 21secs)

Lessons learnt from establishing super-partnerships (10mins 46secs)

Making it work; GP-led and wider engagement (11mins 36secs)

Length of the process (12mins 56secs)

The business plan (13mins 46secs)

Establishing a management team (14mins 45secs)

Finding support through the process (15mins 35secs)

The issues around property (16mins 21secs)

Contacting Martin (17mins 57secs)

Contact Martin at martin.ramsey@mhllp.co.uk

The MHA Macintyre Hudson website is available here

The three previous episodes with OHP are available here: Episode 13, Episode 41 and Episode 79.