A general practice provider federation in a mixed health economy in England – a case study examination

Mitchell, Jill (2021) A general practice provider federation in a mixed health economy in England – a case study examination. Doctoral thesis, Northumbria University.

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Abstract

For over 70 years GP practices have existed within the NHS as independent contractors playing a significant role in the equitable delivery of primary health care. The traditional model of general practice has developed over time, but features such as independent contractor status, the professional partnership business model, and professional autonomy remain as key characteristics. The profession is faced with significant challenges, including increased demand on services with more complex multiple morbidities prevalent in an ageing population, workforce shortages precipitating the need to introduce new disciplines of staff, and the long-term sustainability of the partnership business model. The cumulative effect of these factors challenge the existing model of general practice, and practices are being encouraged to move from what has been termed a small cottage industry (Digby, 1999; Mathers & Lester, 2011; Mathers, 2012) to larger organisational group arrangements. General practice is the empirical setting for this research which adopts pragmatism as a research philosophy within a mixed methods single organisational case study. The study is an example of a GP Federation established as a corporate venture by a group of entrepreneurial GPs. The study examined what insights business theory could offer in explaining how a group of GP practices developed their venture and what advantages and challenges this offered. A mixed methods approach to data collection included interviews and surveys with the executive team who led the venture, GPs, managers and nurses from the member practices, and other senior personnel in the health economy. The activities pursued over an eight-year period (2011-2019) that contributed to strategy were identified, with some aspects of strategy more successful than others. Benefits were realised through activities that all practices participated in, including education, training, research, and quality improvement. A lack of commercial opportunities within the health economy limited the ability to develop a portfolio of services which ended up taking several years to establish. Purpose and vision were identified as important features to ensure continued engagement from practices as sponsors, and the level of investment in leadership and management to dedicate to the venture should not be underestimated. At the beginning of the study in 2011 health policy was focussing on implementation of the Health and Social Care Act (2012) with significant changes introduced in the commissioning landscape. After a period of eight years in 2019, national health policy introduced initiatives to support the ailing sector of general practice through the establishment of Primary Care Networks, and this study reflects on the learning from federated working between 2011-2019 as practices prepared to establish a Primary Care Network though a formal contractual arrangement (NHS England, 2018).

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