The concerted effort to convert PMS Agreements into GMS Contracts, the removal of the Minimum Practice Income Guarantee, the move to a weighted capitation based contract, the withdrawal of enhanced services from individual practices to instead put them out to open tender, the opening up of the NHS Pension Scheme to independent (private sector) providers, the desire from the centre for single point commissioning and the introduction of single contracts for a minimum of 30,000 patients (and rumours that contracts with minimums of 50,000 or even 100,000 patients will soon follow) are forcing changes to the traditional structure and size of GP practices.
At the same time, the NHS is developing new care models to redesign health and care systems, to improve quality of care, reduce health inequalities and address productivity and efficiency challenges. As a direct result of these changes, we are seeing the emergence of super partnerships. These are mergers of primary care practices at a scale never seen before. Whilst it was not uncommon for one or two practices to merge together, and we were beginning to see mergers of 5 to 10 practices, Our Health Partnership (“OHP”) changed the scale completely.
OHP, a super partnership formed by the merger of 37 GP practices in central Birmingham, commenced on 1 November 2015. It has 146 partners and covers a patient population of just under 300,000 which makes it three times the size of the largest existing super partnership and clearly the largest single GP partnership in the UK. Simon Stevens has already met with OHP and supports their ambition to become a Multi-specialty Community Provider and they will have a pivotal role in the development of primary care across Birmingham.
Working with the leaders of OHP, we provided an innovative and secure legal framework for the partnership, providing both the benefits of scale, whilst retaining autonomy at individual practice level. Fundamental for the partners was the principle of retaining a strong element of autonomy over their respective practices, whilst forming one new single partnership. This was successfully achieved and we ensured that the Partnership Agreements of the merging practices were not made redundant by the merger.
The benefits of a super partnership are based on economies of scale and include:
- Working together with local providers in health and social care to develop new and better ways of providing the best
possible care for patients, and to keep patients out of hospital and treated in or closer to their home
- Freeing up time for doctors and clinicians to spend with patients by having management, administrative and
regulatory requirements dealt with centrally
- Providing protection against the risks of competition from other providers
- Supporting the practices and reducing the risk of practices failing and closing, as is happening elsewhere.
These all deliver benefits for patients who are, and always will be, the first priority of a super partnership. There are, of course, a number of important principles and issues to be carefully considered and these include:
- Vision: a merger at scale must have a vision and objectives (most likely linked to the benefits described above)
- Commitment: the merging practices must commit at an early stage to two key principles:
- Democracy: voting is a key issue but the scale of a super partnership means that individual partners (or groups of partners associated with a merging practice) will no longer have the absolute influence that they have in their existing partnerships
- Delegation: the move to a more corporate structure is essential, with a partnership board (supported by an executive team) taking over most of the day to day decision making, with some high level decisions being reserved to the wider partnership. It is interesting to see how quickly those who were initially concerned about losing influence have been surprised by the freedom this actually gives them to concentrate on what they do best – seeing patients
- Autonomy: loss of absolute control is, as described above, a necessary aspect of moving to a more corporate structure. However, there are ways of retaining strong elements of autonomy for partners over certain aspects of their constituent practices within the partnership
- Merger of contracts: this can be a concern but the merger of individual GMS Contracts/PMS Agreements is not necessary at the outset and the partnership can continue with a number of separate contracts and move towards merging them if and when they require
- Staff: mergers often bring about a level of uncertainty, particularly amongst the staff of the merging practices. However, this goes back to the vision and objectives of the super partnership and a merger at scale can actually create a number of new opportunities and progression for staff that can prove to be invigorating and exciting
- NHS Pension Scheme: The NHSPS is notoriously complex and continued access to the NHSPS is vital. Care is therefore needed to structure the merger in such a way as to ensure this is maintained.
We have already been approached by several practices in a number of other locations that were considering traditional mergers but who are now particularly interested in the differences and benefits offered by the super-partnership structure.
For further information or to discuss your requirements in confidence, please feel free to contact us for a preliminary discussion as to how we can support you in taking this forward.
Articles from the newsbrief: The Five Year Forward View and integrated care; Assignment of GP leases; To be in partnership or not to be in partnership; Buying a share in the surgery premises; Who is an appropriate companion at an investigatory meeting; Why leaving that place in the sun may have become easier.