Intended for healthcare professionals

Observations The Best Policy

Why size matters at times of great change

BMJ 2016; 354 doi: (Published 30 August 2016) Cite this as: BMJ 2016;354:i4679
  1. Nigel Edwards, chief executive
  1. Nuffield Trust, London
  1. nigel.edwards{at}

Nigel Edwards considers the possibilities of large scale GP organisations

It might not look like it yet to patients, but general practice is currently embarking on its biggest change since the establishment of the NHS. Our survey earlier this year conducted jointly with the Royal College of General Practitioners of all GPs in England found that three quarters of the 982 respondents had joined a large scale GP organisation.1

These have been springing up to transform the traditional small partnership model across England. They take different forms: some consist of one large partnership, while others are looser networks. Many have hundreds of staff and tens of thousands of patients.

This change started below the radar but has now been noticed, with approval, by policy makers, who have started to encourage it through NHS England’s Five Year Forward View and the Prime Minister’s GP Access Fund, which gives grants to facilitate seven day working. …

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