Should General Practice be more like McDonalds.... or NISA?

GP practice is changing. Some practices are closing, some merging, a lot are federating, you may have even heard of Super-practices where multiple practices join up together.

This later model is particularly interesting as it might be the fore-runner of an accountable care organisation (look it up) which is where the NHS is currently wanting to go.

However this isn’t happening a lot - I only know of a couple and it isn’t yet gaining traction. Getting 2 practices together isn’t easy how do you get 20 or 30? Remember, most general practices are partnerships not limited companies and partnerships are run by individuals with personalities and the right of veto. Change resistant people tend to say no.

Well some have gone for it - some have merged. Why they did it is interesting but not my point. Some have gone for it big time - and created one big super practice with all partners equal with one big over riding contract.

Others have been more cautious and have somehow linked their “backends” whilst keeping their identity and location and their own contract. No one wants to have to drive to a practice they don’t know to cover a GP who is off sick. People don’t want to have to rely on a GP they don’t know well for their QOF points and therefore their income. Keeping things separately means you still run things in your own domain but start sharing behind the scenes.

Practices that have done this start to look at joint procurement, joint purchasing, out sourcing, or pooling staff. Most are very new to this and are taking baby steps.

I believe that general practice probably needs to adopt this later model a lot quicker and we haven’t time to wait for people to learn from the early adopters.

It strikes me there are others out there with experience that need to come into the NHS and help. Note this isn’t privatising the NHS its using the private sectors knowledge and experience and skills to help.

So who are these people? Lets take a franchise. I recently watched a McDonalds be built. It arrives on a trailer. The master company has thought of the best layout, where things should go. The manager has head office training, their management training scheme is meant to be brilliant. The advertising, the sourcing, the products, are centralised, yet the staff are employed locally and dont have to run down the road when someone calls in sick. Wouldn’t this work for general practice?

Plenty of other companies work the same way, next door to me is an Aldi - they do the same.

Nisa was pointed out to me - i dont know much about them other than their website but their idea sounds great. As a small shop owner you can join them. You can keep your own name - or use theirs. They send in experts to look at your customer demographics, they give advice on equipment, stock, layout, branding, advertisements, they make you use their payroll, their accounting package, so they harmonise their data collection, can bench mark and compare. they centrally source and stock things, but allow local variation and local products. It apparently started small - its growing rapidly.

Do we need a NISA style organisation for general practice?