This is the first in three linked blogs where Ben poses three questions that, taken together, will paint a picture of the future of general practice. In this blog the question is:

Will General Practice Remain Independent?

When thinking about what general practice will look like in ten years’ time, one of the questions that immediately springs to mind is whether it will remain independent. Will general practice (finally) become a full-blown part of the NHS, or will it continue in its current peculiar position of half in and half out.

First off, what does independence mean? While the average person on the street considers general practice to be an integral part of the NHS, the description of general practice as independent comes because practices (in the vast majority of cases) are not run by NHS organisations, but by independent organisations (usually GP partnerships) that contract with the NHS.

Is this just a technical difference? Well not really. It means GP partners can choose what they do, which contracts they will enter into, and which they won’t. They can invest in property, form partnerships, decide on their staffing model, and choose how they will operate. They are bound by the constraints of the contracts they enter into, and more recently by CQC regulations, but they retain a level of autonomy and freedom of decision making not available to those working more directly within the NHS.

The opportunity for practices to give up this independence has become much more real recently, since the publication of the GP Five Year Forward View and the emergence of the new models of care. These new models provide what is described as a “fully integrated” option whereby practices can transfer their contract into the new multispecialty community providers (MCPs) or primary and acute care systems (PACS), and the GPs can become salaried employees within the new larger organisations.

Will practices take this opportunity to give up their independence, and if so why? On the podcast, I have asked this question to some of those involved in the new models of care. They explain some will, and the primary reason is the pressure general practice is currently under. For some the workload, financial and leadership pressures have become too great, and focussed on too few individuals. When presented with a way out, they are eager to take it.

For other GPs there is more of a strategic sense that general practice cannot continue on its own. They feel that to thrive into the future and to best serve local communities, general practice needs to work as part of a wider team. They see the future of general practice as no longer being small, independent businesses, but instead operating within a new style of NHS organisation that harnesses the benefits of full membership of the NHS (indemnity, VAT exemption etc), of scale and of fully integrated clinical teams.

But large organisations in the NHS do not have a strong track record of maximising the benefits of scale, of enabling effective multi-disciplinary working or of innovating around the needs of patients. If GPs have learnt anything from the rise and fall of CCGs, it is that the statutory world of NHS stifles rather than enables, creates bureaucracy rather than removes barriers, and controls rather than empowers.

As a result, some prize the independence of general practice much more highly, and are much less willing to give it away. Our Health Partnership (OHP) is a “super practice” with a population of over 200,000 that aims to demonstrate it is possible for independent general practice to thrive into the future, by operating at greater scale. What they, and others like them, are already showing is the choice to remain independent or not is real for general practice, and while changes might be necessary to preserve it, there is certainly no inevitability it will be taken from them.

To thrive into the future, general practice has to change. While some cling to the status quo as a “tried and tested strategy”, the reality of the changed political, social and economic environment is change is necessary. General practice has to operate at greater scale, to manage risk, deliver greater efficiencies, build partnerships and have a strong system voice. But independence is something general practice can choose to keep. Whether or not it will do so I suspect will largely depend on how actively it works at redesigning itself, or the extent to which it allows the system to determine its future form.

If you’d like to find out more about the future of general practice and discuss these issues and many others with Ben and a range of expert GPs then why not buy a ticket to our first ever General Podcast LIVE event next March. You can find all the relevant information and book your ticket here.