Building resilience in General Practice – St Austell Healthcare

Case study summary

The closure of one general practice put significant pressureon the remaining three practices in the area. Rather than struggling individually, the three practices merged to form one new sustainable, multi skilled primary care service.


In August 2014, the largest practice in St Austell (Polkyth) handed back their General Medical Services (GMS) contract, leaving 8,000 patients without a GP. Polkyth’s failure put significant pressure on the remaining three practices in the town.  For twelve months, those practices joined together to run Polkyth using an Alternative Provider Medical Services (APMS) contract and then, following  public consultation, the three practices  merged and all the Polkyth patients were transferred to the new practice.

Primary care services have now been redesigned for the 32,000 patients with an emphasis on upskilling a broad multidisciplinary team (MDT), collaborative working with community (NHS and non-NHS) partners, social care, the local acute trust and an Out-of-hours (OOH) provider. They have improved access by running an acute care hub from the former Polkyth site (open 8am-8pm Monday to Friday).

The merger has saved primary care in St Austell from probable collapse. St Austell Healthcare now have a sustainable clinical and financial model that meets the demands on current primary care and is dynamic enough to embrace future change.

This innovative approach and ability to implement change has been recognised by the National Association of Primary Care (NAPC) and they are currently one of 15 national test sites for the Primary Care Home pilots.

St Austell Healthcare has changed the way it works through:

  • recruitment and upskilling of the clinical and non-clinical team
  • separating urgent and planned care
  • collaborative working with health and social care providers
  • a pioneering social prescribing scheme
  • staff wellbeing reviews
  • high-level financial modelling and advice from a dedicated finance consultant
  • streamlining back office functioning
  • implementation of SystmOne IT Clinical system across all five sites
  • new ophthalmology secondary care service for macular degeneration and glaucoma.

The offer of flexible working and portfolio careers for salaried GPs hashelped with the demands of work and family life. St Austell Healthcare has managed to recruit successfully but their model is based on high patient to whole time equivalent (WTE) numbers (approx. 2,900 patients/WTE), they see investing in their MDT as the key to sustainable general practice in St Austell.

The last 18 months in St Austell have seen huge changes in general practice. St Austell Healthcare feel that the merger has allowed a redesign of their entire business and patient-care strategies.

Dr Stewart Smith, GP Partner said: “Since the merger we have found recruitment easier, we can command higher standards from our management team, collaborative working has improved, we have developed new income streams and crucially our GPs are happier and more positive about the future. We have regular visitors from all over the South West to look at our model and to discuss collaborative working. We are very happy to share learning with practices.”