Key takeaways from the Primary Care at Scale

The day featured presentations, panels, and a lot of insightful conversation about providing primary care services at scale, and the complexities, and rewards, it brings.

Throughout our day, one thing became clear. It is the people that make General Practice successful, and any change must be undertaken with staff, partners, patients and other stakeholders firmly at its heart.

The growth of General Practice

Over the years, the trend within central policy has been for commissioning to target larger and larger patient numbers. As the 'ideal number' of patients within a GP practice continues to rise, the established model of GP practices has adapted. We introduced Jonathan Watmough from HelpingLawyersThrive, who has considerable experience in the expansion of law firms over recent decades. Whilst at first glance, this may appear to be very different, he argued that the challenges faced by the legal sector approaching at scale working mirror those faced within general practice.

Jonathan highlighted lessons already learned within the legal sector from which primary care might benefit, such as the need to avoid institutional autopilot and to identify and harness the current shifts in the landscape. Providers are already being forced to adapt, and Jonathan argued that they should 'never let a crisis go to waste', instead moving with it and using any major change as an opportunity to institute needed behavioural changes within their teams. He emphasised that the people have to be brought along with it, and progress can only be made when people lead from the centre, and bring everyone along with them.

How environmental considerations can affect your funding arrangements and real estate decisions

We heard from Lloyds Bank; Vicky Harper, Healthcare Area Director for the South West and Wales, and Jon Szabo, Regional Healthcare Director. They spoke about the current funding environment, and the importance of speaking to specialists who truly understand the primary care sector. She emphasised the bank's interest in helping practices on sustainability matters, and encouraged delegates to consider what funding they may need in light of national commitments to achieve carbon net zero - without the public funding behind it.

Of course a huge contributor towards carbon emissions is the premises themselves, and this was one of the areas discussed in our Real Estate session, hosted by Rob Hearle and George Todrick, Directors at MPC and Jonathan Webb, Investment Director at Prime. ESG considerations are incredibly important in the modern age, not just in respect of practices' compliance obligations, but also as an attractive factor for incoming partners and staff. This is a major consideration when determining whether or not - and how - to refurbish existing premises or develop new ones and must be given due attention right from the very beginning of these conversations.

Legal structures - do they matter?

VWV partner Oliver Pool and James Granby, Head of Healthcare at Azets discussed whether the current structure of GP practices, typically a partnership, is still the best option in light of the larger organisations that are becoming more common.

Moving to a corporate structure, such as a limited company, limited liability partnership (LLP) or even a community interest company (CIC) can look tempting, as at first glance it could help to mitigate some of the risk that comes with the personal liability of a partnership. Oliver and James gave some food for thought, by arguing:

LLPs are currently ineligible for GMS contracts and so this is not currently a viable option (although if it were to become available in future, many of the issues around limited companies would also be applicable to LLPs).
the GP business already represents a relatively low risk in comparison to many commercial opportunities, so the benefit of switching is limited and may not offset the financial reporting burdens.
the majority of lenders and landlords when faced with a corporate structure would insist upon personal guarantees, which would effectively cancel out any limitation of liability.
CICs may help ease public anxiety over large companies taking NHS GP contracts, however they are subject to an asset lock which prevents them from being used for private gain, making it very difficult to withdraw and realise profits.

One point on which both Oliver and James agreed, as well as contributors from the room, was that the vehicle through which services are provided is much less important than bringing together the best team with a shared vision. Once the primary drivers are understood, your professional team can advise on the pros and cons of different structures and help you to put any necessary documentation in place.

Increased competition

Many at the conference also discussed a growing feeling that GPs must now compete with NHS Trusts, as hospitals seem to be in prime position to adopt the looming Neighbourhood Centre contracts. At a time when so much emphasis has been placed on moving services out of hospitals and into the community, the prospect of trusts potentially taking on primary care contracts may seem surprising.

The afternoon saw a panel session with contributions from leaders from a number of primary care organisations across the country; David Clark, Managing Partner at Mendip Vale Medical Practice, Rachel Beverley-Stephenson, Chief Executive at OneMedical Group, Jessica Bawden, Chief Executive at Lakeside Healthcare and Dr John Ribchester, Director of Strategy at Whitstable Medical Practice. The session was chaired by Ben Willis, Partner and Head of Healthcare at VWV.

There was lively discussion about the importance of remaining relevant, and that collaboration with trusts will be key: primary care providers should seek out trusts' leadership, find out what their challenges are, and work with them to determine how local GPs can help. There are GPs in Integrated Care Boards and those roles will be lonely - it's a perfect opportunity to make allies.

Making the best use of data

A recurring theme of the day was that an often unharnessed benefit of working at scale is the significant amounts of data that primary care providers can now access. Delegates from a variety of practices all commented on how they had been able to make use of the data they had collected. For example, practices have been able to model community need within specific branches so they can effectively match staff resources to best benefit the patients. Analysis can also determine the overall impact of initiatives such as wellbeing advisers. GP practices are perfectly placed to use this data effectively as it is tailored to their local area, which leads to another big theme of the summit's talks: the importance of autonomy.

Different populations around the UK come with different needs and different challenges, and GP practices should remain local and autonomous to deal with this. Being able to adapt to the needs of the local community and make decisions on how to fulfil these needs at the operational level is a real asset for practices. This is mirrored within practices on an individual level.

Encouraging independence which builds success

Another of the similarities between law firms and GPs which Jonathan Watmough had pointed to was the tricky task of managing high-performing professionals who value their autonomy. You can get the most out of people by ensuring that staff feel that they are led from the centre of their organisation, rather than managed from the top. This allows each individual the flexibility to use maximise their own knowledge and skillset.

Individual practices must investigate and develop a management model that works for their staff as well as their patients. As the primary care landscape continues to change, GP Practices need to take stock of what works for them in the current system so they can campaign to preserve it. Practices who do not have a seat at the table may well end up on the menu.

Key takeaways from the Primary Care at Scale - Senior Leaders' Summit