Collaboration in general practice: Surveys of GP practice and clinical commissioning groups

Working at scale in collaborative arrangements is widely accepted as the future of general practice. In 2015, the Nuffield Trust and the Royal College of General Practitioners (RCGP) published the results of two surveys. This survey found that 73% of practices were already operating in collaborations and were motivated to do so by financial pressures, a desire to expand the range of services offered, and CCG encouragement.

In 2017, we conducted a further two surveys, sent to general practice staff and to CCG staff, that aimed to find out what had changed in the landscape of general practice and to explore what GPs feel the future holds for them.

These surveys were conducted as part of the RCGP and Nuffield Trust’s ‘General Practice at Scale’ programme. This slide pack brings together the responses from 565 GP practice staff and 51 CCG staff.


Triaging patients using ‘telephone first’ approach may increase GP workload

Study finds wide variation among practices in how the ‘telephone first’ system impacted GPs – but showed overall it was associated with increased workload | GP Online | BMJ

A telephone first approach in general practice is likely to increase overall GP workload and there is ‘no evidence’ that using the scheme saves money, researchers have found.


The study, published in the British Medical Journal (BMJ) analysed data from 147 GP practices in England using the approach and compared them with a 10% random sample of other practices in England. They also reviewed responses to patient satisfaction surveys.

The researchers found adoption of the approach led to fewer face-to-face consultations – from a mean of 13 to nine per day per 1,000 patients – and more telephone calls – from a mean of three to 12 per day per 1,000 patients.

They concluded that these results suggest that much of the work of a GP can be managed on the telephone,  but almost half of the patients triaged needed to be seen in person – effectively doubling the length of time for a GP to deal with their problem.

Patient responses to the scheme were also mixed, with some welcoming that they could be seen more quickly in telephone first practices, and others finding it more difficult communicating over the phone.

The scheme also led to an increase in emergency admissions, which the researchers warned could increase overall costs to the health system.

Full story at GP Online

Research paper: Newbould J. et al. Evaluation of telephone first approach to demand management in English general practice: observational study  BMJ 2017

RCGP strategic plan

The Royal College of General Practitioners (RCGP) has published Great doctors, great care: RCGP strategic plan 2017-2020.

The plan sets out the College’s four main objectives for the next three years which are:

  1. Shape the future of General Practice
  2. Ensure GP education meets the changing needs of UK primary care
  3. Grow and support a strong, engaged membership
  4. Be the voice of the GP (influence)

The College has also identified 12 values, which can be summarised in four ‘core’ values:

  1. Excellence
  2. Teamwork
  3. Leadership
  4. Care

Full report: Great doctors, great care: RCGP strategic plan 2017-2020.

8 out of 10 patients are positive about GPs

As the NHS treats more patients than ever before, a new nationwide survey shows the majority of people are positive about their GP care – with almost 85 per cent rating their overall experience of their GP surgery as good | NHS England


The GP Patient Survey 2017 compiled responses from more than 800,000 people across the country on their experience of healthcare services provided by GP surgeries, including access to GPs, making appointments, the quality of care received from GPs and practice nurses, satisfaction with opening hours and out-of-hours NHS services.

The majority of patients (84.3%) say they were able to get an appointment the last time they tried and around seven in ten patients (68%) say it is very or fairly easy to get through to someone at their GP surgery on the phone.

The survey found that confidence and trust in GPs remains extremely high at 91.9%, while almost three in four patients (77.4%) would recommend their GP surgery to someone who has just moved to the local area and 72.7% of patients rated their overall experience of making an appointment as good.

There has also been a marked improvement in the awareness of online GP services, with more patients saying they are aware of how to book appointments (up 3.8% on last year to 36.1%), ordering repeat prescriptions (up 2.6% to 34.1%) and access to medical records (up to 8.9%).

However, it also suggests areas for improvement, with one in ten patients (11.3%) saying they weren’t able to get an appointment – an increase of 0.5% on the 10.7% in 2016. And the number of patients reporting they can usually see their preferred GP dropping to 46.2% – down by 2.4% on last year.

GPs to refer patients to libraries to promote access to reliable health information

GPs will be able to refer patients with long-term conditions to public libraries from this month under a charity-led scheme to promote access to reliable health information | GP Online


A reading list of 28 trusted books for patients with long-term conditions, stocked by all public libraries in England from this month, has been drawn up under the scheme, backed by the RCGP and organisations including Public Health England.

The books on prescription scheme for patients with long-term conditions is an extension of the existing Reading Well programme, launched by charity the Reading Agency and the Society of Chief Librarians.

Thousands of GPs already refer patients to libraries under the existing scheme, which has focused on areas including mental health and support for patients with dementia and their carers.

Effect of online health information on GP consultations


Research published in the British Journal of General Practice has explored how searching for online health information before visiting a doctor influences patients’ behaviour during the consultation.

The effect of Dr Google on doctor-patient encounters in primary care looks at the effect of searching online health information on the behaviour of the patients as well as how the GP handles this information.  It concludes that the use of the internet by patients is not seen as a threat by GPs and leads to a better mutual understanding of symptoms and diagnosis.

Full reference: Noor Van Riel et. al. The effect of Dr Google on doctor–patient encounters in primary care: a quantitative, observational, cross-sectional study 


Additional link: RCGP press release

Access to General Practice

Concerns persist over patients’ access to GPs and staffing levels


The House of Commons Public Accounts Committee has published Access to general practice: progress review. This follow-up report finds that the Department of Health and NHS England now have objectives to improve and extend access to general practice and have made some effort to understand the demand for extended access.  However, the committee notes that extended hours are being introduced without an understanding of the level of access currently being provided, or how to get the best from existing resources.

The report also notes that despite the government’s target to recruit 5,000 more GPs, the overall number of GPs has reduced in the last year, and problems with staff retention have continued.

Health Education England has increased the number of trainee GPs recruited, but still did not manage to meet its recruitment target last year.