The impact of new forms of large-scale general practice provider collaborations on England’s NHS: a systematic review

Pettigrew, Luisa; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

doi:10.3399/bjgp18x694997

Cited by 16 publications

(31 citation statements)

References 20 publications

(29 reference statements)

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“…There is a growing interest in the topic of general practices working together, 61 with various researchers seeking to add to the knowledge on this topic. We designed this study to be different from, but also complementary to, other approaches that emphasise large-scale data collection via surveys 118 and/or that focus on federations, which may be more developed than is typical, nationally.…”

Section: Methodsmentioning

confidence: 99%

“…A recent systematic review of new forms of large-scale general practice provider collaborations in England 61 (see Appendix for more detail) found that larger scale could contribute positively to sustainability in general practice through standardised processes and operational efficiency, maximising income, enhancing the workforce and deploying technology. However, it highlighted the significant levels of leadership and resources needed to create, develop and maintain these organisations.…”

Section: General Practice Collaborative Working: a Recent Historymentioning

confidence: 99%

“…A recent systematic review of the literature on new forms of large-scale general practice provider collaborations in England concluded that 'good-quality evidence of the impacts of "scaling up" general practice provider organisations in England is scarce'. 61 Only five studies met the inclusion criteria and four of these focused on developments in the same London borough. [135][136][137][138] These assessed the impact of an initiative by Tower Hamlets PCT in 2008/9 to incentivise collaboration to deliver packages of care in four clinical areas between 2009 and 2012 using funding of £10M, which was recycled from other initiatives.…”

Section: Appendix 1 New Forms Of Large-scale General Practice Providementioning

confidence: 99%

“…In addition to identifying impacts on outcomes, the literature review identified useful lessons in relation to the process of working at scale. In particular, it noted that '[s]ubstantial financial investment was required' 61 to establish the collaborations and associated interventions. Quality improved in the targeted areas, with a combination of standardised processes, federation-level incentives, IT-enabled performance dashboards and managers at the federation level said to be key contributory factors.…”

Section: Appendix 1 New Forms Of Large-scale General Practice Providementioning

confidence: 99%

“…In addition, the authors identified patient concerns relating to the tension between the goals of the commercial enterprise and public goals of service quality. Pettigrew et al 61 also suggest that federations of existing practices should be investigated as these may reap the benefits of working at scale, but are less likely to clash with GP autonomy and may be better able to maintain continuity of care. In the Tower Hamlet examples, the sites included were actively involved in the delivery of clinical programmes and were financially incentivised to do so.…”

Section: Appendix 1 New Forms Of Large-scale General Practice Providementioning

confidence: 99%

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The impacts of GP federations in England on practices and on health and social care interfaces: four case studies

McDonald

Riste

Bailey

et al. 2020

Health Serv Deliv Res

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Background General practices have begun working collaboratively in general practitioner federations, which vary in scope, geographical reach and organisational form. Objectives The aim was to assess how federating affects practice processes, workforce, innovations in practices and the interface with health and social care stakeholders. Design This was a structured cross-sectional comparison of four case studies, using observation of meetings, interviews and analysis of documents. We combined inductive analysis with literature on ‘meta-organisations’ and networks to provide a theoretically informed analysis. Results All federations were ‘bottom-up’ voluntary membership organisations but with formal central authority structures. Practice processes were affected substantially in only one site. In this site, practices accepted the rules imposed by federation arrangements in a context of voluntary participation. Federating helped ease workforce pressures in two sites. Progress regarding innovations in practice and working with health and social care stakeholders was slower than federations anticipated. The approach of each federation central authority in terms of the extent to which it (1) sought to exercise control over member practices and (2) was engaged in ‘system proactivity’ (i.e. the degree of proactivity in working across a broader spatial and temporal context) was important in explaining variations in progress towards stated aims. We developed a typology to reflect the different approaches and found that an approach consisting of high levels of both top-down control and system proactivity was effective. One site adopted this ‘authoritative’ approach. In another site, rather than creating expectations of practices, the focus was on supporting them by attempting to solve the immediate problems they faced. This ‘indulgent’ approach was more effective than the approach used in the other two sites. These had a more distant ‘neglectful’ relationship with practices, characterised by low levels of both control over members and system proactivity. Other key factors explaining progress (or lack thereof) were competition between federations (if any), relationship with the Clinical Commissioning Group, money, history, leadership and management issues, size and geography; these interacted in a dynamic way. In the context of a tight deadline and fixed targets, federations were able to respond to the requirements to provide additional services as part of NHS Improving Access to General Practice policy in a way that would not have been possible in the absence of federations. However, this added to pressures faced by busy clinicians and managers. Limitations The focus was on only four sites; therefore, any federations that were more active than those federations in these four sites will have been excluded. In addition, although patients were interviewed, because most were unaware of federations, they generally had little to say on the subject. Conclusions General practices working collaboratively can produce benefits, but this takes time and effort. The approach of the federation central authority (authoritative, indulgent or neglectful) was hugely influential in affecting processes and outcomes. However, progress was generally slower than anticipated, and negligible in one case. Future work Future work would benefit from multimethod designs, which provide in-depth, longitudinal, qualitative and quantitative methods, to shed light on processes and impacts. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.

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Section: Methodsmentioning

confidence: 99%

Section: General Practice Collaborative Working: a Recent Historymentioning

confidence: 99%

Section: Appendix 1 New Forms Of Large-scale General Practice Providementioning

confidence: 99%

Section: Appendix 1 New Forms Of Large-scale General Practice Providementioning

confidence: 99%

Section: Appendix 1 New Forms Of Large-scale General Practice Providementioning

confidence: 99%

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The impacts of GP federations in England on practices and on health and social care interfaces: four case studies

McDonald

Riste

Bailey

et al. 2020

Health Serv Deliv Res

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Scaffolded contributions, active meetings and scaled engagement: How technology shapes informal learning practices in healthcare SME networks

Treasure-Jones

Sarigianni

Maier

et al. 2019

Computers in Human Behavior

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Lessons for ‘large-scale’ general practice provider organisations in England from other inter-organisational healthcare collaborations

et al. 2019

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The number of large-scale general practice provider collaborations is growing in England.  Expectations of what they will achieve are significant.  Trade-offs exist between mandated/voluntary collaborations; networks/single organisations; and different governance structures.  Better Improved clinica outcomes and cost savings do not automatically result from 'scaling-up'.  Policy-makers should move in this direction with caution, informed by ongoing evaluation.

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The impact of new forms of large-scale general practice provider collaborations on England’s NHS: a systematic review

Abstract: Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why.

Cited by 16 publications

References 20 publications

The impacts of GP federations in England on practices and on health and social care interfaces: four case studies

The impacts of GP federations in England on practices and on health and social care interfaces: four case studies

Scaffolded contributions, active meetings and scaled engagement: How technology shapes informal learning practices in healthcare SME networks

Lessons for ‘large-scale’ general practice provider organisations in England from other inter-organisational healthcare collaborations

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