Single GP practices on the way out – what next for primary care?

The Nuffield Trust has published a report showing a reduction in the number of small, single-doctor traditional GP practices. The health policy think tank has called for a combination of funding increases and network creation between GPs as the key moves to make the transition into new models of care while achieving economies of scale and more efficient care. Figures show the number of GP practices run by single doctors has declined from 1,717 in 2006 to 891 last year, at the same time that practices with more than 10 doctors have grown by 75%.

The trend towards bigger, multi-disciplinary primary care organisations is evident throughout the rest of Europe and is considered as a more suitable model to treat an ageing population with more complex needs, but the funding squeeze on the health sector has hampered that progression. Latest figures show a 3.8% decrease in spending on GP services from £7.84 billion in 2012-2013 to £7.55 billion in 2013-2014. Despite these figures, a number of practices are coming up with innovative ways to offer their services and to tailor them to the needs of different patient groups.

The Nuffield Trust report underlines that the move to larger practices and the formation of networks and federations between GPs is the best model to ensure further expansion of the innovation already taking place. Complementing GP activity, political leaders should facilitate the transition to this new type of GP professional model by ensuring GP contracts are prepared accordingly, while making better use of data in policy formulation and avoiding a top-down control that could be overly prescriptive and “strangle” emerging innovation.

In this “brave new world” of emerging large-scale GP practices, an often overlooked aspect by policy makers and pundits is estates. The delivery of new primary care models cannot possibly be delivered through premises that can sometimes date from Victorian times. What is required is the development of fit-for-purpose, modern premises that can house a number of healthcare professionals and specialties, offering a wide range of services in one location and potentially going a step further through the incorporation of public services in the same location. The primary care estate is an issue that will have to be on the radar of decision makers, if any of the Nuffield Trust recommendations are to be implemented and if the trend towards a wider service offer by primary care is to be reinforced.