The pivotal role commissioners play in GP working at scale

The momentum behind the concept of General Practice working at scale has increased exponentially over the last couple of years.

Whilst this trend is a positive step towards realising the vision laid out in the GP Five-Year Forward View the multiple pressures facing GP practices (in particular the instability at practice owner level) will undoubtedly mean that more will need to be done to actively and proactively encourage and support collaborative working if the long-term stability and sustainability of general practice is to be secured.

The role CCGs and commissioners more generally have in this process cannot be understated. Having worked with both struggling practices and those looking to work collaboratively (whether via a practice merger, GP network or otherwise) there are clear and mutual benefits to commissioners who adopt a pro-active strategy when it comes to encouraging and supporting the concept of working at scale and the various options that are available to achieve it.

From a commissioners’ perspective, the core benefit of the strategy is that it focuses on providing planned proactive support as a means of addressing contractor instability which if left unchecked would spark the need for unplanned reactive measures (whether practice closures, caretaker providers or otherwise). Such measures can prove time consuming, expensive and destabilising.

Given the benefits, there is real merit in every CCG actively adopting and prioritising a proactive strategy when it comes to supporting and encouraging those who are looking to work at scale. Whilst not an exhaustive list, such strategies should cover:

• Early engagement
  The number one focus of any strategy should be the creation of those forums and resources necessary to spark early discussions on collaborative working. This will go a long way towards encouraging proactive collaborations that are planned properly and implemented positively and carefully.
  
  
• Contractual support
  Any strategy for supporting working at scale should seek to both address the perceived rigidity and complexity which surrounds the handling of core NHS contracts and the process for approving sub-contracting arrangements. This perception can prove a real obstacle to those contractors looking to work in innovative and collaborative ways. It is, however, rare that a proposal (whether in its original form or with subtle alterations) is not capable of being realised within the flexibility (albeit limited) that already exists within the contract regulations. A prime example is understanding the types of individuals and (to the surprise of some commissioners) corporate entities that are capable of holding core NHS primary care contracts.
  
  
• Financial support
  Whilst obvious, being open and transparent on the potential financial support available will be a crucial part of any strategy. Whether this support originates from resilience funding, the cost directions or otherwise, the funding that is available is usually one of the key factors for contractors (particularly those that are proceeding proactively as opposed to reactively) when it comes to the decision to proceed yet it remains one of the most uncertain and elusive areas.