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£500m savings plan set to shift workload to GPs amid trust merger

GPs in one region of England may have to shoulder an increasing burden of patient care as part of radical plans to transform general practice.

Nottinghamshire’s draft sustainability and transformation plan (STP) - the blueprints for the future of the NHS currently being designed across England - has outlined how resources will be shifted to primary care following the merger of two acute care trusts.

The area is facing a funding shortfall of £500m by 2020 if it does nothing to reshape its services.

And David Pearson, STP lead for Nottingham and Nottinghamshire, said that the merger of the Sherwood Forest Hospitals Foundation Trust and Nottingham University Hospitals NHS Trust in 2017 'provides an opportunity' to rethink the system.

NHS England are looking to increase the amount of services provided by primary care providers, in line with its Five Year Forward View plan to move towards new models providing both primary and secondary care.

In Nottinghamshire, this is being piloted via the Mid Nottinghamshire Better Together Primary and Acute Care System (PACS) vanguard, which aims to 'deliver a whole system integration of hospital, community, social and primary care within a single outcomes-based capitation contract'.

But the STP reveals plans to shift work into primary care on a wider scale.

The Nottinghamshire STP says: 'To gain clarity on the pathway to financial sustainability as a system brought about through demand management; active cost management and increased productivity; aligning resources and incentives with collective decision making; developing new contracting and payment models; service and pathway transformation resulting in improved value; together with a new model of out-of-hospital care enabling the resizing of acute hospital services.'

A spokesperson for the Nottinghamshire STP said: ‘[The proposed merger of Sherwood Forest Hospitals NHS Foundation Trust and Nottingham University Hospitals NHS Trust] provides an opportunity to consider the best ways of delivering clinical services for Nottinghamshire patients.

‘We are planning to strengthen primary and community care services to reduce unnecessary admissions and facilitate the optimum length of stay.

‘In order to address the financial gap we will continue to consider innovative new ways of delivering health and social care services that are more cost effective, improve the experience of service-users and bring care delivery into more convenient settings, closer to people’s homes.’

But GP leaders warned that moving work form hospitals to primary care will only work if this is 'resourced', and it would not be enough to just supply funding, according to Nottinghamshire LMC.

LMC chair Dr Greg Place told Pulse: 'We are aware of these plans and there's also at the same time pressures not to refer people [to secondary care services]. People are trying to watch what they do, the CCG is cutting back on funding procedures of limited therapeutic use. So there's all sorts of things up in the air.

'But this about sending things back to primary care is great if it's resourced. It all comes down to the resourcing, and it is not the resource in terms of money for work done. It's the resource in terms of the manpower needed to do the work, and it's the resource in terms of where do we do the work, and it's the resource for training the staff to do the work.'

Dr Place said there was 'no point' in commissioners telling GPs that 'if we give you the money they you can build the premises and employ the people'.

He said: 'That is not good enough. We can't do that, because we are absolutely saturated at the moment. If they really want to, within the STP, remodel primary care, then it needs to be properly remodelled. We are saturated ground - pour more water on us and it will run off now.

'There is very little flexibility within the present system, but restructuring probably needs to be done from the bottom up, starting with premises, staffing, and training.'

In other areas of the country, GP surgery numbers are being slashed as part of long-term plans to make savings.

In North London, practices with list sizes under 10,000 patients could face closure amid moves to create primary care ‘hubs’ with lists of 30,000.

And in the South West, Dorset is looking to reduce the number of primary care sites in a bid to keep remaining services open for more hours and days of the week.

Note: This article was amended at 11.12 on 18 October to correctly attribute quotes to the lead for the Nottinghamshire STP





Readers' comments (15)

  • Lot of management guff which equates to dumping work on primary care with minimal funds to follow. If the GPs agree to this they are idiots.

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  • Hoping to prevent and shorten hospital admissions to reduce workload is as stupid as the idea that we are preventing illnesses because in the vast majority of cases we are not. What is being achieved is the postponement of many illnesses until later in life and often much later, the problem is then one of multiple pathologies in elderly, worn out patients and the admissions will be longer than ever and likely to end in multiple 'revolving door' admissions and then death. The sooner this is explained to the media, politicians and general population the better. Unrealistic expectation is killing the NHS.

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  • 'GPs best placed'
    'we got to think of patient care'
    'we are a resilient bunch'
    'we owe the NHS / public'

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  • Adequate funding of social services by addressing the age old problem of means tested social care and "free" health care is one giant step to solving the problems. That has been fudged for generations as health is a vote winner! Having one budget means the debts can't be pushed around the system, and the public made aware of the total cost of health and care. Pushing the problem into primary care will cause it to finally collapse and then there will be just massive increases in A+E and costs.

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  • we all need to keep an eye on STPs.
    No CCG should be allowed to progress any plan without the membership agreeing.

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  • They all need to say no to this if not properly resourced. They cant force tit through.
    As it stands it sounds dangerous for patients and staff.

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  • I completely understand the CCG's position.

    If there's an all you can eat buffet provided by someone else, why would you be willing to feed people yourself?

    Whether the GPs in the area will do something about it, that's a different question altogether.

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  • I work as a GP partner in this area. I've heard all this stuff before but any actual plans or information? you must be joking! GPs haven't agreed to anything

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  • Time to change our contracts from a capitation based one to an activity based one...this is what the BMA and RCGP should be fighting for.

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  • I am not 100% sure that when the STPs talk about primary care they mean practices. More likley are providers of community services (DNs, social workers etc) with GPs working alongside but independent of practice (bit like OOH). Practices may be unable to take on additional work and could continue as they are.

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