The future of general practice in England is in the political and policy spotlight, with existing general practice services seen as both the problem and the solution to addressing current NHS challenges. Part of the solution is seen to lie in ‘scaling up’ GP practices into larger organisations or networks capable of delivering a wider range of better coordinated services in the community. Indeed, the Five Year Forward View provided a clear indication that large primary care organisations are to be the national direction of travel.

Current work  

It is clear from recent surveys (e.g. BMA May 2014, BMA April 2015) that collaboration between practices is commonplace. The latest BMA survey suggests that over a third of GPs say their practice has joined a network or federation. Although many federations and networks remain in the early stages of development – the formation of some having been triggered by the Five Year Forward View – several have been evolving over the preceding years. These established organisations are the subject of the Nuffield Trust’s new research programme.

To help policy-makers and practitioners respond to the challenges ahead, the Nuffield Trust is undertaking a two-year project which seeks to track, support and evaluate a sample of these established large-scale general practice and primary care organisations.

The project will explore whether such organisations are delivering anything distinctly different from the ‘traditional’ small-scale general practice model in terms of a range of measures including impact on patient and professional experience, clinical quality and financial sustainability.

The work will be taking a case study approach, using mixed methods to understand the evolution, governance and priorities of organisations. A quantitative component will examine data from member practices against a range of comparable indicators. Intra-organisational analysis will offer insight into whether practice performance has converged over time. Case study sites are indicated below.

The full aims of the work are:

1. To understand emerging models of general practice in terms of: their aims and objectives; organisational design; their activity; service development work; and the context within which they are forming.

2. For a subset of organisations: to assess their impact on clinical quality and outcomes; professional and patient experience; and to understand the factors that have helped and hindered their development.

3. To develop new methods for evaluating the performance of primary care.

4. To learn from, and provide support and challenge to, a small group of general practice organisations as they develop.

5. To contribute to the national policy debate about the future role of general practice and primary care within the NHS.

GP Learning Network 

As part of this programme of work, we have established a general practice learning network for established large-scale GP organisations. The network will run for two years from Summer 2014 and will offer participants the opportunity to:

  • make contact with, learn from, and challenge similar organisations;
  • share ideas and work out solutions to problems with peers;
  • engage in, and shape, discussions about the future of general practice and primary care
  • derive developmental support from peers and expert speakers.

The network will also provide a valuable source of intelligence and insight about the changing world of general practice that will help to ground the research and ensure it produces relevant and current recommendations. 


The learning network and case study research will be complemented by two national surveys that will seek to build on the BMA surveys and to provide much-needed information about the form that new organisations are taking and the challenges they are seeking to overcome.


There will be regular blogs, short papers and presentations that will be published as this work progresses. A final report detailing findings of the research will be available in 2017. News of relevant events will be advertised on the Nuffield Trust’s website. We hope that the work will provide a useful insight into this under-researched and dynamic area.

Case study sites

Four large-scale GP provider organisations were selected as case study sites for this research work. The four were selected from the twelve members of the learning network (see here for full list). The sites were selected to provide a spread of different governance types, locations, sizes and priorities. In this way, we hope to maximise the learning that can be derived from the work. The four sites are: 

Harness: GP Federation located in North West London, established in 2006. Harness currently has a population of around 110,000

GP Care: GP Federation located in Bristol. Established in 2006, the organisation covers a population of 850,000.

Vitality: a GP super-partnership in Birmingham. Covering a population of 60,000, the organisation was founded in 2009.

AT Medics: a multi-practice organisation operating a dispersed model across south, east and west London and surrounds. Covering a population of just under 100,000, AT Medics was founded in 2004.

If you have any questions about these strands of work please contact Stephanie Kumpunen.

Other relevant work

The Nuffield Trust is working in partnership with the Royal College of GPs to deliver an NHS England-funded network to support the development of emerging GP provider organisations. The network will be virtual and will provide a range of materials for emerging organisations or for practices exploring the benefits of collaboration.

Previous work

The Nuffield’s current programme of work builds on previous work that looked at the emergence of new general practice organisations internationally and created a typology of organisational form.

Project outputs

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