Form or Function, which comes first in new models of Primary care at Scale?

May 25 2018

Do the circumstances practices and practitioners find themselves in due to funding, work load or workforce crises dictate that a new form is needed to enable primary care to be sustained?  Or are organisations forming to meet specific needs of their population whether they be improving care pathways, efficiency, to increase opportunities for workforce development or have a stronger voice for primary care at local or regional level?

Is one approach better or more effective than the other?

Of course just as there is no one answer to what size of organisation constitutes GP at scale, so too both form and function are sides of the same coin.  Wherever a new organisational structure develops or more collaborative working occurs all are determined by local circumstances to which GPs have always responded so we can best provide care for our patients.

At a recent meeting at RCGP where leaders of some collaborative networks across England met, although in different forms and at different stages in their organisations development it became apparent that common to all whether driven by form or function was the deliberate choice to form trusting relationships with others from outside their own practices.  It was the extent to which these relationships developed both internally and externally that appeared to determine the organisations progress.

Leaders described the need to invest in ‘Trust and Relationships’ as organisations and systems formed and described how much time this takes and is therefore a step in organisation or collaborative development that can be overlooked.  Perhaps rather than financial security or organisational form or even a defined function that lay it was the development of relationships that lay behind the finding in the RCGP / Nuffield trust survey earlier in the year suggesting that organisations were most likely to achieve their purpose after 2 years?

Finally, please do share your experiences of working at scale as well as any ideas for future poll question, discussions, or activities with the network or directly with me ( to help us develop a real learning resource for those GPs wanting to learn more or work at scale.

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