Primary care must change to meet needs of population, says report

Hand holding a glowing lightbulb

The King’s Fund has just published this report, which describes how the health and social care workforce are coming up with new models for delivering primary care, to support the “current system of commissioning”. The report is aimed at commissioners, GP staff, and related stakeholders, including social care and local authorities, and promotes improved liaison between all these groups to ensure stronger collaboration and networking, to provide a more integrated service to patients.

Contract and pen

The report starts with an explanation and short history about the GP contract

GP contract

The report starts with an explanation and short history about the GP contract, describing the main variations, and the requirements for contracting for additional services, such as out-of-hours provision, minor surgery, and locally agreed priorities, for example, sexual health screening, weight management, etc. Figure 1 is useful, (although a bit blurry), as it lists the different funding streams together with the core contracts and the additional contracts.

GP talking to a patient

GPs are encouraged to work together to improve health care across the whole network

Case studies

A number of innovative case studies are included, looking at different settings:

  • Town and country – with 41 practices
  • Large urban area – 94 practices
  • Inner-city area with ethnically mixed population – 36 practices
  • Large rural area – 82 practices

Table 2 is also very useful, as it provides an overview of the case study settings, which describes the patient population, the Clinical Commissioning Groups they work with, the areas they want to collaborate on, the contract types they apply, and what they have achieved, namely “reduced spending, increased vaccination rates, better management of long-term conditions, reduced unplanned admissions and A&E attendances, and improved working relationships with other providers.

The report looks into quality, accountability and performance measurement, and describes how the different settings organise their activities, measure performance, and promote improved partnership in different, innovative ways to support the needs of their populations. By sharing the risk, GPs are encouraged to work together to improve health care across the whole network.

The word impossible, with the im being rubbed out

The authors describe the key challenges that can hamper future GP provider development

Challenges to innovation

Whilst innovative practice is important in terms of improving quality and value for money, it is not always easy to develop new models of care. The authors describe the key challenges that can hamper future GP provider development:

  • Structural instability
  • Shifting accountabilities
  • Provider engagement
  • Payment models

The final section explains what support is needed and available, and suggests approaches that can be taken forward. This is very much an example of good knowledge management in practice, where, rather than working in silos, people work together and learn from each other, which is something that has been actively encouraged in the NHS since 1999.


This is a focused report and helpful because it looks at the various settings where GP practices sit, so it can be applied by everyone working to support commissioning in England. It has long been known that sharing knowledge improves practice, particularly when learning about what has not worked. One of the CCG managers interviewed pointed out that one of the benefits to commissioners, is that “….you’ve got a combined wealth of knowledge, risk, clinical delivery opportunities of four or five combined practices as opposed to putting all your eggs in one basket.” So, the risk is shared, which means that mistakes are likely to be spotted. Also, if GP surgeries are working together, patients can expect a standardised service across the locality. GP practices should work with Clinical Commissioning Groups to identify existing and potential networks. Perhaps within your own practice you could think about your informal networks, people you trust, who you go to when you want to discuss professional issues. How could this be formalised, and what innovative practices can you share?


Commissioning and funding general practice (PDF)
R Addicott, C Ham
The King’s Fund
February 2014

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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