Could New Models of General Practice Provide Safe Haven?

GPs Facing Perfect Storm – Could New Models of General Practice Provide Safe Haven?

General Practice is in the middle of a perfect storm of multiple pressures: growing and unsustainable workloads, rising public expectations, a harsh funding environment, a crisis in recruitment and retention, as well as falling morale. According to research by the BMA, 90% of GPs report that unmanageable workloads are undermining the quality of care that they provide to patients


Urgent solutions are required to build resilience and scale in general practice. This would see GPs working in larger teams but retaining the crucial benefits of independent contractor status and the professional autonomy that brings. It seems clear that a practice based on a small ‘cottage industry’ model is no longer sustainable.

If properly constructed, new models of GP practice can bring clear benefits:

  • allowing GPs to retain autonomy, self-determination and independent contractor status, whilst improving work-life balance
  • cost efficiencies through operating at scale – procurement costs savings of 20-30%, savings on CQC fees, audit and medical indemnity premiums
  • achieving operational efficiencies from operating at scale and ability to secure and afford essential key strategic corporate and business services as spread across a much wider base
  • securing investment in premises, new technology and information systems to enable you to provide a first class service to your patients
  • building multi-disciplinary care teams offering new career pathways which can help to recruit and retain the best people
  • capacity to bid for new contract opportunities as they arise, as well as resilience to cope with peaks and troughs in workload
  • opportunities for working across communities with charitable and voluntary organisations, social enterprises, housing associations and educational establishments

In developing models at scale, it is inevitable that individual GPs and practices will need to cede a degree of autonomy and authority to a central leadership team. They key question: is that loss of sovereignty and independence more than compensated for by the economies of scale, resilience and increased bargaining power the new grouping can bring?

“The best organisations seem to have an inner self-confidence and discipline to pursue their mission and implement change despite wider turbulence in local or national systems” – Mark Britnell, HSJ January 2013

What are the options for future models of general practice in the light of the NHS Five Year Forward View and the Sustainability and Transformation Planning Guidance 2016/17? What are the features of different legal formats and what commercial issues do GPs need to consider?

Forward View Group, in association with Elderflower Legal, has published a special report examining the options for GPs and commissioners to design new models of practice. Download your free copy here.


[1] BMA, Future of General Practice (2015)



Mark Johnson is Chair of Forward View Group – a consortium of values-driven professionals passionate about creating new service models which enhance health and wellbeing for both patients and practitioners: