The evaluation of large-scale collaborations between primary care general practices

Background General practice is under mounting pressure to ensure its future sustainability. Collaborations between GP practices are perceived as one way to respond to these pressures and they have been mandated by The NHS Long Term Plan.

Aim The aim of this study was to investigate the facilitators, barriers, impacts, and costs associated with collaboration.

Method A rapid evidence assessment was carried out between September and November 2018. Publications over the last 20 years were eligible for inclusion if they were in English and covered any high-income OECD country. Publications between 1998 and 2012 inclusive, were limited to reviews only. No methodological restrictions were applied to publications between 2013 and 2018. A total of 52 publications were included for final data extraction (36 academic and 16 grey literature).

Results Facilitators of GP collaboration include strong leadership, external support, trusting relationships, clear roles and objectives, and mutual shared history/vision. Barriers to collaboration were tied to an absence of key elements such as lack of clarity, core skills, time, human resources, trust, financial support, face-to-face interactions, and leadership. Positive impacts of collaboration included the delivery of high-quality health care, better clinical health outcomes, and improve employee satisfaction while negative impacts included challenging GP autonomy, feeling overwhelmed by workload, and a reduction of continuity of care for patients.

Conclusion There are numerous facilitators to GP collaboration. Barriers are often present as an absence of facilitators. Further research is needed to evidence the impact(s) and cost-effectiveness of GP practice collaboration.