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Practice merger case study: Teldoc, Shropshire

In Telford and Wrekin CCG, three practices came together in April 2017 to form an organisation covering 45,000 patients, 17 GP partners and two salaried doctors, called Teldoc. The practice is now the largest GP partnership in Shropshire.

Its practice director Wayne Cooper says that the main driver behind the move was a need to remain ‘sustainable and resilient’ amid a general practice system suffering soaring demand, recruitment problems and tighter funding.

‘No different to anywhere else our CCG is keen for primary care to take on more services from secondary care and for services across health, social care and the community to be seamless,’ Mr Cooper says. ‘It’s about greater collaboration.

‘At the same time we need to boost income levels, which we think means moving away from relying only on GMS funding. Pursuing these aims and goals isn’t feasible as a single practice. Being a bigger organisation gives us opportunities to offer more services locally for our patient population.’

Financial issues

The merger was not all plain sailing. Along with the standard financial, legal and organisational issues the practice had to grapple with they had additional financial issues to consider – parity of earnings between partners and complications around property.

Parity of earnings for partners can often be a stumbling block for many practice mergers. To address the issue the Teldoc practices had an initial frank discussion about their expectations and then sought expert advice from a specialist accountancy, explains Mr Cooper.

‘They reported on our level of earnings and put together a proposal on how we might achieve parity. That was a valuable investment. Currently, we are on schedule to getting to our agreed level of earnings.

‘Property is another thing we had to plan since we have nine sites,’ he adds. ‘We looked at our entire property portfolio and agreed we needed to put leases in place between the property-owning partners of each building and the new partnership.’

IT was another key challenge. Integrating the clinical systems was relatively straightforward, the practices found. What was more testing was unifying different clinical protocols and staff working systems.

‘The change of technology is the easy part,’ warns Mr Cooper. ‘It’s how the technology is used and reconciling different procedures and systems staff use that is difficult. We decided to delay integration of the clinical systems until we were ready.’

Management board

A merger can also require practices to rethink the way they operate. Mr Cooper says they have created a management board, chaired by a GP and with representation from all founding practices, that meets weekly to make and drive decisions. 

So what are the benefits of the mergers, to date? Teldoc says it has made progress in improving how it handles demand. It is working towards introducing a split of routine care from urgent care which hopefully will see the use of 15 minute appointments for routine care and phasing in a system that allows patients to book appointments at any of its sites.

There has also been a distinct improvement in recruitment. Mr Cooper believes this is because the practice’s bigger size means workload can be better managed and there is more scope for career progression.

‘We have attracted lots of interest from GPs, advanced nurse practitioners and practice nurses and have been able to increase our clinical workforce as a result of the merger,’ he says.

‘We are still at an early stage but we feel we have boosted our resilience and sustainability. It has set us up to put in place ambitious plans to take on a range of care services.’

Medeconomics Guide to Practice Mergers

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