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How mergers could protect the future of GMS contracts

Merging can help 'traditional' general practice compete in the new NHS, writes Dr Robert Morley

Midlands Medical Partnership was formed from eight practices merging. Pictured: (L-R) Dr Ibrahim Varsan, general manager Sarah Longland, Dr Dave Sangha,  Dr Robert Morley and Dr Sunando Ghosh (Photograph: UNP)
Midlands Medical Partnership was formed from eight practices merging. Pictured: (L-R) Dr Ibrahim Varsan, general manager Sarah Longland, Dr Dave Sangha, Dr Robert Morley and Dr Sunando Ghosh (Photograph: UNP)

No one can doubt the enormous, far-reaching changes that the NHS has recently under­gone and will continue to undergo.

When I and a number of like-minded colleagues first thought about merging our practices several years ago it was in response to these chan­ges, and in particular the obvious danger posed to ‘traditional’ general practice by APMS contracts held by commercial providers.

Our vision when creating Midlands Medical Partnership (MMP) was to improve and develop all that is excellent about traditional GP services – local GPs leading and working in local surgeries to provide long-term doctor/patient rel­ationships based on the established values of trust and personalised care – while at the same time being part of a larger, more corporate business structure.

This would allow us to survive, compete and prosper in the new NHS, whatever changes, including commercial competition, came our way.

Opportunity for practices
At the same time we saw this as an opportunity for our practices and patients to benefit from the resources of a larger business. This would enable us to improve and develop the range and quality of services, access, responsiveness and learning across our org­anisation.

We defined our core purpose as ‘to work within a culture of quality to constantly improve the care and service we give our patients’.

It was clear that the only way to achieve our goals was through continued GMS partnership. Only this all­ows the security of nationally neg­otiated terms and conditions and, more importantly, the long-term contract, which has enabled UK general practice to be the world’s best and the cornerstone of the NHS.

When, as initially seven separate practices, we first discussed our plans with our two PCTs they were, unsurprisingly, very keen to allow us to merge under a single APMS contract.

But regardless of any possible practical advantages, as well as any short-term financial incentives, we refused to throw away the security of GMS to enter a time-limited APMS contract.

Midlands Medical Partnership (MMP)
  • 28 partners; seven salaried GPs.
  • Total of 121 employees.
  • 52,000 patients.
  • Eight surgeries.
  • Two GMS contracts with two PCTs.
  • Five-partner management board.
  • Single general manager; nine surgery/office managers.
  • GP training, including advanced training.
  • Medical student teaching.
  • Full range of enhanced services including invasive minor surgery, IUD/etonogestrel implant, drug abuse, nurse-led extended hours.
  • Outside posts of partners include LMC secretary, subdean, VTS course organiser, urogynaecology clinical assistant, local authority medical adviser, CCG board member.
  • Joint venture with GP co-op out-of-hours provider to run local Darzi centre.
  • Visit www.mmpmedical.com for more information.


The process of merging
The merger process itself was a complex affair, but we benefited greatly from our expert teams of legal and financial advisers, who also provided project management.

We have ended up with a comprehensive partnership constitution including various deeds, profit-sharing principles and policies which act as templates for any future mergers or new partner appointments. The initial merger of the seven founder practices took place in April 2009 and an eighth practice joined us last year.

As our merger took place, a Darzi centre was commissioned and two new APMS practices were procured very close to three of our surgeries.

If anything indicated that our strategy was on the right track, this was it, and everything that has happened since then, including the Health and Social Care Act, has reinforced that view.

The Darzi centre was seen as a particular threat and because of this we formed a joint vent­ure with our local GP co-op and successfully bid to run the centre.

I have no doubt that had we not merged and formed MMP and been in a position to put in such a strong bid with the GP co-op, the centre would have ended up in the hands of a private commercial provider.

Looking ahead
So what of the future? Well, as GP partnerships go we are big, but I still don’t feel anywhere near big enough to be best-placed to face all of our future challenges.

I look at the changes in the NHS and where it will be in five to 10 years. I see commercial providers contin­uing to gain more GP contracts, particularly with the increasing number of singlehanders ret­iring.

I see clinical commissioning groups (CCGs) being domin­ated by these providers and privatised commissioning support organisations performance-managing general practice.  

Foundation trusts too will be on a more commercial footing and increasingly competing with private providers. This will threaten existing relationships between GPs and local hospitals and it is essential that practices have the size and clout and can punch their weight in their dealings with them.

We are also all aware of the burdens that Care Quality Commission registration and revalidation will soon bring, especially to smaller practices.

Additionally, I fear a genuine prospect of practices having to bid against private firms to provide enhanced services.

The advantage of being in a large corporate partnership gives us the capacity and expertise to do this, as well as positioning us to take the opportunities of new work generated through secondary to primary shift.

My biggest fear is that the GMS contract itself will be lost. We hear talk of moving to a ‘unified national contract’, but there is no detail on this as yet.

In some ways, among all these destructive NHS changes, it seems inconceivable that the GMS ‘contract for life’ will be allowed to continue.

If it does go, that would be a tragedy for general practice, our patients and the NHS. However, we will continue to do all we can to ensure that MMP is best positioned to secure its future, and that of GP-led general practice.

  • Dr Morley is a GP in Sutton Coldfield and chairman of Midlands Medical Partnership

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