Large-scale general practice in England: what can we learn from the literature?

"Traditional general practice is changing. Three-quarters of practices are now working collaboratively in larger-scale organisations – albeit with varying degrees of ambition and organisational integration. Policy-makers and practitioners have high hopes for these organisations and their potential to transform services both within primary care and beyond. But can we be confident that they can live up to these expectations?"

Large-scale general practice in England: what can we learn from the literature?
L Pettigrew, N Mays, S Kumpunen, R Rosen, R Posaner
Nuffield Trust
September 2016

Read more here.

Lessons for large-scale general practice

"This study examines the factors affecting the evolution and impact of large-scale general practice on staff, patients, the wider health economy and the quality of care. The study combines an extensive literature review and national surveys with an in-depth mixed-methods evaluation of contrasting, large-scale general practice organisations that includes detailed case studies."

Is bigger better? Lessons for large-scale general practice
R Rosen, S Kumpunen, N Curry, A Davies, L Pettigrew, L Kossarova
Nuffield Trust
July 2016

Read more here.

The multispecialty community provider (MCP) emerging care model and contract framework

"This document defines what being a multispecialty community provider (MCP) means by assembling features from the 14 MCP vanguards into a common framework. In turn, the 14 will be adopting or adapting the framework for their diverse local communities, as they progress from their current status as aspirant MCPs towards full maturity."

The multispecialty community provider (MCP) emerging care model and contract framework 
NHS England
July 2016

Read more here.

Understanding pressures in general practice

"This report looks at patient factors, system factors and supply-side issues to see what lies behind this increasing pressure on general practice. It finds that despite GPs being at the heart of the health care system, a lack of nationally available, real-time data has made their changing workload largely invisible to commissioners and policy-makers."

Understanding pressures in general practice
B Baird, A Charles, M Honeyman, D Maguire, P Das
The King's Fund
May 2016

Read more here.

What the Commonwealth Fund’s 2015 international survey of general practitioners means for the UK

"The survey findings show that there are certain aspects of care where the UK performs strongly. Indeed, in some cases (such as the use of electronic medical records) the UK is an international leader. However, the survey also highlights a number of areas of concern, in particular that UK GPs find their job more stressful than any of their international counterparts."

Under pressure: What the Commonwealth Fund’s 2015 international survey of general practitioners means for the UK
S Martin, E Davies, B Gershlick
The Health Foundation
February 2016

Read more here.

Test result communication in primary care

"Our study has shown that the potential for error in the TRC [test result communication] process is large yet seemingly unrecognised in general practice. Staff have yet to introduce technological solutions with the result that the robustness of the system hinges on patients who may be unaware of their responsibility to retrieve results and in many cases act as the system fail-safe."

Test result communication in primary care: a survey of current practice
I Litchfield, L Bentham, R Lilford, RJ McManus, A Hill, S Greenfield
BMJ Quality and Safety 2015;24:691–699. doi:10.1136/bmjqs-2014-003712

Read more here.

Indicators of quality of care in general practices in England

"In the summer of 2015 the Health Foundation was asked by the Secretary of State for Health to review indicators of the quality of care provided by general practices in England. We looked at how indicators could be developed to generate meaningful information that supports improvements to care and helps the public choose which practice might best meet their needs."

Indicators of quality of care in general practices in England: An independent review for the Secretary of State for Health
J Dixon, E Spencelayh, A Howells, A Mandel, F Gille
The Health Foundation
October 2015

Read more here.

Patient safety implications of general practice workload

"This discussion paper looks at fatigue among GPs – as caused by persistent and excessive workload – its potential impact on patient safety, and methods available to improve this situation in future."

Patient safety implications of general practice workload
Royal College of General Practitioners
July 2015

Read more here.

Transforming general practice

"Financial incentives are most likely to stimulate transformational change if they are large scale and high profile – with finances and reputations at stake if they fail"

Transforming general practice: what are the levers for change?
R Rosen
Nuffield Trust

June 2015

Read more here.

General Practice in England

"This briefing paper provides general background for Members and their staff on NHS primary medical services provided by general practitioners (GPs) in England. It gives an overview of commissioning arrangements as well as information on changes to GP contracts and funding arrangements."

General Practice in England
Commons Briefing papers CBP-7194
E Blow, T Powell
May 2015

Read more here.

Risk or reward?: The changing role of CCGs in general practice

"In our case study sites we found that the sustainability of clinical involvement in commissioning was at risk due to waning levels of GP leader engagement in CCGs, potential problems in the recruitment and retention of leaders, and significant pressures on GPs’ time and capacity."

Risk or reward?: The changing role of CCGs in general practice
R Robertson, S Ross, L Bennett, H Holder, J Gosling, N Curry
The King's Fund
January 2015

Read more here.

Collaborative Care and Support Planning

"The Collaborative Care and Support Planning programme aims to encourage a shift in general practice to bring the person with long term conditions (LTCs) to the centre of the decisions which are made about their care, working in partnership with the practitioner."

Collaborative Care and Support Planning
Royal College of General Practitioners
January 2015

Find out more and watch a video about the programme here.

Delivering Higher Value Care Means Spending More Time with Patients

"Attempting to improve a physician’s productivity by placing arbitrary limits on length of appointments or setting high targets for the numbers of patients that he or she should see each day lowers costs at the front end of a care cycle. But they incur much higher costs later in the cycle when preventable complications are treated in emergency rooms and intensive care units."

Delivering Higher Value Care Means Spending More Time with Patients
DA Haas, YC Krosner, N Mukerji, RS Kaplan
Harvard Business Review
December 2014

Read more here.

Understanding quality improvement at scale in general practice

"Improvement guidance derived largely from hospital-based studies is, for the most part, applicable to improvement efforts in primary care settings, although large-scale change in general practice presents some particular challenges. These need to be better understood and addressed if improvement initiatives are to be effective."

Understanding quality improvement at scale in general practice: a qualitative evaluation of a COPD improvement programme
M Marshall et al.
British Journal of General Practice, 2014; 64(629): e745–e751. doi:  10.3399/bjgp14X682801

Read more here.

Patient Online support and resources

"This guide is intended for GPs, general practice staff, clinical commissioning groups (CCGs) and commissioning support units (CSUs) who are providing support to GP practices implementing Patient Online."

Patient Online support and resources
NHS England
November 2014

Read more here.

Is general practice in crisis?

"This briefing provides an evidence-based overview of the current state of general practice in England, and offers some potential solutions. It examines demand for GP services, the GP workforce, funding, and standards of access and quality of care. It then presents four ideas to help solve the problems facing general practice – and the wider NHS."

Is general practice in crisis?
M Dayan, S Arora, R Rosen, N Curry
Nuffield Trust
November 2014

Read more here.

Health leaders' survey 2

"Ahead of the 2015 election, we will be regularly surveying a panel of 100 health and social care leaders for their views on a range of issues, including the state of the NHS and social care system and what they believe should be the priority areas for reform during the next Parliament."

Health leaders' survey two: the state of general practice
Nuffield Trust

Read more here.

Framework for responding to CQC inspections of GP practices

"From October 2014, the CQC will begin to roll out their new inspection regime to inspect and rate every GP practice in England by April 2016. Practices will be inspected across five key questions, considering the extent to which they are safe, effective, responsive, caring and well-led. They will be rated in one of four categories; outstanding; good; requires improvement; or inadequate."

Framework for responding to CQC inspections of GP practices
October 2014
Commissioning Operations, NHS England

Read more here.

Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice

"Given the need for coordination between specialist and generalist care for the task of insulin initiation, this study's results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE?s to play a boundary spanner role in this process."

Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey
J Manski-Nankervis, I Blackberry, D Young, D O’Neal, E Patterson, J Furler
BMC Health Services Research 2014, 14:515  doi:10.1186/s12913-014-0515-3

Read more here.

A pharmacist-led ulcerative colitis review service

"This case study describes a pharmacist-led ulcerative colitis review service which was commissioned by Bushloe End surgery in Leicester."

A pharmacist-led ulcerative colitis review service: Improving medicines adherence in general practice: Quality and productivity collection
Bushloe End surgery
NICE
October 2014

Read more here.