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GPs go forth

GP practices looking to merge with hospital trust to 'de-risk' future

Exclusive Up to five GP practices are looking to offload staff and have their properties bought by the local hospital trust in order to stay open, Pulse has learned.

The long-term aim is for the local Southern Health NHS Foundation Trust-led Multispeciality Community Provider (MCP) ‘vanguard’ to be directly contracted to provide GP services - something which is not currently possible under GMS arrangements, the MCP’s GP clinical lead said.

In the meantime, one practice in Gosport has nearly finalised merger negotiations that will see two GP partners forming a new provider arm with Southern Health, while the trust will take over employing all the other practice staff and the leasehold for the practice premises.

And, according to Southern Health, up to five practices are seeking similar agreements with the same trust, in the face of increasing demand and a shrinking GP workforce. A trust spokesperson said ‘a handful’ - clarified as ‘three or four’ - other practices had expressed interest in such a move.

The MCP vanguard spans 30 GP practices across South Hampshire, the majority of which remain independent contractors. NHS England’s new models of general practice vanguard programme includes GP practices and hospitals working together in larger organisations providing both primary and secondary care. Aside from the MCP model, nine hospitals have been approved to pilot directly providing GP services under the vanguard scheme, prompting GP leaders to warn practices may be ‘devoured’ by hospitals.

But Dr Donal Collins, a GP in Fareham who is clinical lead for the vanguard led by Southern Health, said the trust was ‘de-risking the job’ for GP partners so that practices could survive and sustain services for the local population.

Dr Collins said: ‘Essentially they are looking for a way of de-risking the job, taking the property out of the equation, having a guaranteed, reasonable income.

‘Southern can then put other people in the practice because they have access to physios, community psychiatric nurses and so on, who can see patients and with the multidisciplinary approach and then the practice can survive.’

The new arrangement with the Gosport practice, which serves around 9,500 patients, involves some of the GP partners forming a ‘shell company’ with Southern Health that will hold the GMS contract, as the trust cannot legally take over a GMS contract itself.

The remaining practice staff – both non-medical and medical – will become employees of Southern Health. The spokesperson for the trust said negotiations with the practice ‘are progressing well’, and were ‘aiming for October implementation’.

Dr Collins stressed the trust arrangement was not seen as a long-term solution for practices in the vanguard area, and that the MCP would aim to form an organisation to hold GP practice contracts in future.

He said: ‘We need to find a way so that ultimately these practices will come within the MCP – so Southern’s strategic view is they are essentially holding and minding them until the MCP is in such a shape it can take on these practices within the bigger organisation.’

He said that the MCP taking on practice premises forms a key part of the plans, and in the case of the Gosport practice will mean the trust taking over the practice leasehold.

Dr Collins said: ‘The risk was the practice could have gone under, and then individual partners would be liable for rent on empty building.

‘One of the plans for MCP would be for those who want to give up lease, or MCP would invest in owner occupied premises, then create a stronger primary care at scale.’

Southern Health has already signalled its willingness to help rescue GP practices in need, having signed up to NHS England South’s formal panel of providers contracted to temporarily take on the running of GP practices having to close at short notice, but the arrangement with the practice in Gosport is intended to be permanent.








Readers' comments (18)

  • GPs and Acute Hospitals working together to remove this artificial barrier is good news.

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  • Wouldnt like to do this with my local DGHs as they are very very bankrupt

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  • Premises is the next disaster for us GPs in our 50s not far from retirement. New partners understandably dont want to buy in. If we dont start doing something like this I see that my colleagues and I will be selling our premises off for housing development and there will be a big hole in GP premises need.

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  • I suggest to my naive colleagues that they ready again and again the very first comment by the NHS Manager, who wants all to be his/her clerks.
    No more independence, but "Yes Sir/Ma'am, dear chief executive."

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  • 'Wouldnt like to do this with my local DGHs as they are very very bankrupt'

    Snap! Mine are very very very bankrupt!

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  • I will be interested to see what happens to the legal status of the GP partners. If the hospital trust employs the staff and owns the buildings, what business is left for there to be partners in? If they dissolve the partnership because there is no business left, to be self employed GPs and be paid a fee by the hospital trust, it won't be long before HMR&C takes an interest and it is HMR&C, not the individual, who ultimately decides if you are legally a self-employed person or an employee. You can't claim to be a locum in this case so there is a decent risk that HMR&C will declare them to be employees of the Hospital along with all the other staff.

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  • Vinci Ho

    It becomes a matter of how to survive in each individual case with an alternative .MCP and PACS are going to converge into one type of model .
    The question is if the new model is really that 'efficient' and still serves for the best interests of our patients . Of course , the official answer to that is YES......

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  • Anonymous | Practice Manager | 08 September 2015 11:55am - If you can substitute, you're probably ok. Chances are they could maintain a partnership around the core contract, and essentially 'outsource' everything else to the acute - a pretty savvy model which would remove most of the liabilities from the partners.

    This is the way we should all be going. And recognise that premises are only really valuable whilst there is NHS reimbursement backing. As practices are pushed to get larger, the small premises will be unfit for purpose, and the value as housing stock will be considerably less. Good time for sale and lease back or this sort of deal. Get your equity out GPs!

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  • Instead of being goaded into 'working together'/ 'working smart' etc, one needs to look at own perspective and plan accordingly. The push is to get people working together and then going out for privatization under the garb of 'smart one stop' clinics.
    Good properties will never lose value and especially if they are purpose built. Contracts may come and go - the mortar stays forever. You can join private health clinics and become a branch or convert to provide a different service altogether instead of sticking to NHS primary care services at the beck and call of the establisment stooges.
    Outright sales are acceptable but leases are rife with the danger that tomorrow the holder of lease may also decide to give up the Contract and then you may be left with nothing.
    In some cases, leases may be drawn by parties with owners just to get them out and then liquidate the contract.
    We've had examples of multinational companies being bought and then being closed so why could this not happen with Surgeries.This is the best way NHSE could get owners out of properties. Liquidating contracts therafter would result in huge savings from saved rents. Patients could be relocated to existing underused LIFT projects where NHSE has to pay anyway.

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  • There is certainly some kind of scam in which buildings are rated by the DV for medical use at a high rate, paid for by the NHS at this high rate, yet the alternatives uses (housing, commercial) do not represent this.

    Is this a way to keep NHS GP practices from leaving the NHS, as rent is one of their biggest outgoings?

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