General practice is changing.  Whether we like it or not, the tectonic plates of the NHS are shifting, and as a result general practice is not able to stand still.  These changes will have an even bigger impact on practice managers than on GPs themselves.

In October last year the 5 Year Forward View for the NHS was published.  It heralded new models of care that are explicitly designed to close the gap between primary and secondary care, primary and community care, and primary and social care.  In March the first 29 ‘vanguard’ sites were announced, with huge expectation that they will be at the forefront of a new movement for change.  The move is to new accountable care style organisations, whereby new organisations that incorporate providers from across a combination of general practices, community trusts, social care provider, and even hospital trusts, take on a capitated budget for a population and drive whole system change.

14 of these new Vanguard sites are ‘multispecialty community providers’ (MCPs), in which GP group practices will expand, bringing in nurses and community health services, hospital specialists and others to provide integrated out-of-hospital care. These practices will shift the majority of outpatient consultations and ambulatory care to out-of-hospital settings.  More are expected to follow in year as part of the ‘fast follower’ programme.  Co-commissioning of general practice by NHS England and CCGs will further accelerate this change.

These changes have serious implications for general practice.  The MCPs will cover populations much larger than those covered currently by most practices.  The size of the budgets the new organisations will be taking on will be much bigger than those managed by general practice at present.  A capitated budget for a population of 50,000 is going to be somewhere in the region of £50M.  And the roles and skills needed to run these organisations are also going to be different.

One of the MCP vanguard sites is Vitality, a GP Partnership in Birmingham operating across 15 practice sites and serving a population of 70,000.  In management terms they have a Managing Director, a Finance Director and finance assistant, a Head of Operations, a Governance and Quality manager, a HR officer, two business administration managers, an IT manager and an informatics officer.  Another of the MCP vanguard sites is Lakeside Surgeries in Corby, which is bringing together a population of 100,000.  They have Robert Harris, former national Director of Strategy, as a non-GP ‘General Partner’ and full equity partner.  All very different from a traditional practice!

Some of the other MCP sites include the CCGs.  It may well be that for some of the smaller CCGs those working in the CCG will take up roles in the new MCP organisations.  In others management staff may come from the existing community provider.

General practice as it is carried out today will continue into the future.  If anything it will be enhanced, built upon, strengthened, even protected, as it provides the foundation for the new models of care.  It is, and remains, the jewel in the crown of the NHS.  But while general practice will continue, the way that it is managed will not.

We have already seen the development of new types of management structures, and indeed new types of senior managers, within general practice as it expands.  This development will accelerate quickly as the new changes take hold.  What this marks is the beginning of the end of practice management as we know it.

The future holds challenge and opportunity.  Practice managers today could be the leaders of the new MCPs in future.  Or they could be managers of different buildings and services within the new organisations.  Or they could provide the management expertise of primary care that is uniquely held within the practice manager community at present.  Or they could become obsolete.  The challenge is to act now to get ready for the future ahead.

Written by Ben Gowland