In a GP survey last November, only 16 per cent of family doctors were optimistic about the future. The main perceived threats were private providers, difficulty maintaining profits and loss of professional status.
However, practices will succeed if they understand what they are good at and find ways of using those skills.
In future GPs are expected to take on more secondary care work and need to prepare for a Healthcare Commission inspection regime similar to that in hospitals. GP practices have been threatened before and have always risen to the challenge by recognising their strengths. Practices can do this again by joining forces locally and forming consortia to bid for more services.
GPs have consistently outperformed rigidly structured and managed organisations such as NHS hospitals by their ability to create more responsive businesses, with autonomy, a superior end product and better working conditions. While hospitals focus on themselves and the purchaser, practices focus on patients and satisfying patient demand. This is likely the key to future success.
Planning new services to market to the primary care organisation (PCO) and providing quality data is a challenge for small businesses. The best way to meet these challenges is to set up a consortium.
GPs can remain as partners in their own practices although individual practices may do slightly less as the consortium (made up of its constituent practices) develops its skills. The consortium can do the strategic thinking and design new services to sell to the PCO and for practices to achieve.
Creating a consortium demands compromise at practice level. It will not prosper unless practices want to work together, and for this the driver should be to develop local practices. Working together also fits well with practice-based commissioning.
Holding the budget allows the consortium to change services and create funds to add new services provided by practices and to commission additional specialist services in the community. But, for this to happen the management structure needs to be strong.
By specifying a set of rules and allowing the practices independence of method — much like the PCO does with the quality framework — the consortium can be responsive to its members without allowing one practice’s wishes to scupper developments. For example, the consortium does not need to decide on practice staff structures or internally manage practices.
Practices themselves must be well managed and capable of organising their teams to produce consistently high clinical standards. This should suit those GPs who want to see patients and shape the practice environment to deliver high quality care but do not want to run a consortium or manage other practices. The GP partners as managers of their own businesses should each take on a role in the practice that plays to their individual strengths.
To prepare, practices should start by understanding themselves. They can analyse the partners’ team working skills using an online tool such as Belbin Team Role Analysis (www.belbin.com) to see who keeps the practice together when there are difficulties.
Creating a balanced practice is as important as new ideas and forcing change.
If the practice wishes to proceed with consortium development, it needs to find and meet other like-minded practices. Start in a social setting involving all the partners, managers and nurses. Follow this up with a more structured meeting to gain confidence and to find out the skills on offer. Avoid talking about joint working just with the GPs who have the big ideas. If practices are to retain autonomy, the consortium also needs those who can bring out the best in others.
If these meetings go well, the potential members will need to take an interest in what goes on within the practices. Another series of meetings should be planned to work through issues of importance to practices.
Giving all partners a role in running the practice can be difficult but, is easier to achieve with an organisation above the practice to support but not control. GPs benefit from better-run practices and, potentially, job roles in the consortia or even at the private companies shaping the future.
Successful group working requires leadership and the spreading of skills. But it is the way forward if GP practices are to compete successfully with private providers.
Cheshire GP Dr Spooner is an RCGP council member with interests in practice based commissioning, management and quality assurance