New large-scale practice groups are helping GPs and their staff cope with growing pressures – but show little sign so far of delivering improvements in quality or patient satisfaction, a think-tank report says today.

The study of four organisations with a total of 150 practices between them found them failing to stem overall declines in patient satisfaction.

Researchers at the Nuffield Trust found some improvements in prescribing practice – but no improvements in other forms of quality.

The four organisations are either limited companies or partnerships.

The study found they had successfully pooled resources and brought in extra income – and this was often reinvested.

They also tackled staff shortages through collaboration, sharing and developing staff.

The researchers found slow progress in undertaking NHS England’s ambition that large GP organisations would take on specialist services and district nursing.

Dr Rebecca Rosen, a GP who is a fellow of the Nuffield Trust, said: “It is important that political and NHS leaders don’t let expectations of these new organisations run away from the reality.

“These are early days, but so far we see no sign that larger organisations are leading to better standards of care. Taking on new services is a major task and will take time.”

The Royal College of GPs said the report showed a “number of benefits” from large-scale working.

Chair Dr Maureen Baker said: “In particular, it highlights how working at scale can help sustain GP services, innovate in the best interests of patients, and enable GPs to develop leadership skills.

“More research needs to be done to evaluate the long term benefits of GPs working at scale, and there are challenges that need to be addressed, but it is certainly encouraging that this report has found quality has not reduced as a result of large scale general practice.”

But the Patients Association said patients seemed to be excluded from decisions about changes to general practice.

It pointed to a finding of “little patient involvement” in the decisions – and that patient participation groups were used to help design shared services after being told a decision had been taken.

Chief executive Katherine Murphy said: “It is concerning that the Nuffield Trust were unable to detect marked differences in the quality of service provided despite concerted efforts to achieve improvements. Likewise, the Patients Association are disappointed to learn that patients were not involved in the process of GP enlargement from the beginning.

“It is vital that patients are on board with healthcare changes from the start to ensure that patients remain at the heart of everything the NHS does.”