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New GP contract to mandate practices to join primary care networks

Exclusive GP practices in England can expect changes to their contract from April mandating them to join networks of 30-50,000 patients in return for a major funding boost, Pulse has learned.

The BMA's GP Committee is in the final stages of negotiating the changes following the long-awaited publication of the NHS long-term plan, which will see primary and community care receive an extra £4.5bn by 2023/24.

The new contract is also likely to see changes to QOF and a review of funding the immunisation schemes, the long-term plan says.

Under the plans, all local enhanced services are likely to be funded by CCGs through the networks.

GPC chair Dr Richard Vautrey told Pulse that the 2019/20 contract changes, which have yet to be signed off, will require practices to join primary care networks but that no practice would need to give up their GMS contract as a result.

The long-term plan says that the 'vanguard' programme - which saw GPs working in networks and covering larger patient groups - has been successful and can now be rolled out across England. As a result, GP practices will be told to enter into a network contract 'as part of a set of multi-year contract changes', and 'as an extension of their current contract'.

The plan says: 'The £4.5bn of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people.

'As part of a set of multi-year contract changes individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will flow.'

It adds: 'Most CCGs have local contracts for enhanced services and these will normally be added to the network contract.'

The networks will have 'expanded neighbourhood teams', which the plan says 'will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs such as physiotherapists and podiatrists/chiropodists, joined by social care and the voluntary sector'.

As well as this, the plan suggests other changes to the GMS contract, including:

  • Changes to QOF, which will se  a new Quality Improvement (QI) being worked up with the RCGP, NICE and the Health Foundation, while the 'least effective indicators will be retired'.
  • A ' fundamental review of GP vaccinations and immunisation standards, funding, and procurement' in 2019 in a bid to improve immunisation coverage.

Dr Vautrey told Pulse: 'Practices are already starting to develop networks covering 30-50,000 patients. This is a contractual change that will facilitate and support that. We will have more detail on that as soon as we finalise the contract.

'Every practice will be part of a network. How they engage with that will be for them to determine but I would hope that the contract changes will make it beneficial for them, to be part of working with colleagues across an area.'

He added that this would mean 'retaining your GMS contract'.

'This builds on this contract and will not replace it. Nobody will have to give up their existing contract,' he said.

NHS England said in 2017 it was expecting '100%' of GP practices to cover networks of 30-50,000 patients by 'around 2019'.

 

Related images

  • Dr Richard Vautrey

Readers' comments (33)

  • Peter Swinyard

    Just for once this is not something to get all worried about but a mechanism for getting money into groups of practices. The redevelopment of the Primary Care Team as a Multidisciplinary Team at PCN level is very welcome and will reduce silo working where we are working against district nurses etc instead of with them.

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  • Skilled workforce. The age of the professions is over. For better or for worse.

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  • It’s genius in a way. They have worked out how to invest in primary care while ensuring individual practices don’t increase profits without providing additional services. Shame there won’t be many practices left to bid for this additional work.

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  • Why?

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  • National Hopeless Service

    Shit just got shitier.

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  • De-professionalising doctors just got worse.

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  • We’re graphically isolated with an elderly population. Not sure ‘one size fits all’ works for everyone.

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  • Mandating things doesn't always improve the work environment make staff "play nicely!" I find.

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  • This is nothing new. GP surgeries will close or merge. A hub model will develop. GPs are expensive-so many will be replaced by cheaper alternatives. Patient care will decline--but the traditional way of providing care is no longer sustainable. Is this the 14th 10 year plan since the NHS started?

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  • Ivan Benett

    An excellent development, essentially replicating Manchester model. Great opportunity for locality integrated teams, extended same day access, better long term condition management and continuity of care.
    BUT needs more capacity with a larger workforce to meet the needs of the locality population (which varies from one to another depending on demography and economic factors). In particular need a smaller case load per GP. Greater opportunity for flexibility of career choice and specialisation

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  • Bob Hodges

    We're doing this already, which is why we merged in the first place. Some funding would be nice though.

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  • Really does mean the end of Partnerships running General Practice. Get out now. This is General Practice entirely on the Government [of the days] choice. The bureaucrats must be rubbing their gold plated pencils devising many hoops you'll have to leap though to bid for their work. This will be General Practice as per protocol. To meet certain demands that shows a policy is working.
    GP was and should be about continuity of care - that's where the long-term savings really are. Enlarging Practices without the capable, experienced and committed workforce will only undermine this. It will have to be run by managers set on hitting a target. How often do we experience duplication of investigation? Good money is going back into general practice. Bad - it's too late. The current belief that technology will solve the nations health problems is bizarre. Technology, good as it is has also created the problem. Good luck to you all as I am now there.

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  • David Banner

    The final nail in the small partnership coffin. Mind you, there were plenty of nails hammered in to us over the last few years. It almost comes as a relief, to be honest.

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  • Why does seem like more of the smelly soggy brown stuff we have been fed over the past 5 years oh yes it still is more of the same.Cant see how this will increase funding, decrease workload or stop the exodus.Pathetic.

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  • In theory, this is not one size fits all as you could arrange the MDT in such a way as to suit your patient population.

    For elderly, more staff to support care homes and a better social model.

    For a more rural population, better visiting services and remote working, etc

    In theory..

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  • Let common sense prevail

    I am notoriously resistant to change, but in this case do not feel overly anxious. By forming small groups we can still retain control over how we run our own practices, so I think these developments may potentially preserve the independent partnership model and continuity of care. I can buy into this one (although the devil is always in the detail).

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  • Funding will work when corruption ends especially in some areas of the southeast.

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  • This model has been implemented in Wales for some 8-10 years.
    What is the governments favourite tactic when it comes to defending NHS England?
    - some thing along the lines of,"you ought to be thankful you don't live in socialist controlled Wales."

    I know we're not good at looking at best practice elsewhere in the world eg the Antipodes,but come on,how about somewhere that is less than 100 miles from Whitehall,that would make a good start.

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  • Reality: GPs leaving/retiring early. Surgeries closing down.

    Narrative: let's create "networks" (because we don't have enough staff and surgeries are closing down).

    A lot of this stuff is clearly government propaganda. They are clueless about how to deal with the healthcare crisis and have simply retrofitted a narrative to make it look it's part of a grand plan instead of desperation.

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  • Really from my point of view this is ok.
    There’s enough self delusion and incompetence in the plan to keep me happy. So a few enthusiasts want to squander the goodwill of the few remaining doctors by enforcing more pointless dogma. So what.

    I don’t think any medical staff will be about to undercut my rates in the few years I’ve got left.

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  • Practices are in competition to attract patients on their list. how can you work together. two take away food sailing same food to join together!!!!!
    poor small practices.

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  • The BMA once again putting it's "save the nhs" agenda ahead of the interests of it's members. Anyone daft enough to fund them deserves the salaried serfdom that awaits.

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  • Beware all ye English GPs... look closely at the Scottish contract, and the ‘cluster model’ being tried up here. When QOF abandoned in Scotland GP clusters were formed of supposedly similar types of practices and localities to become the driving force for ongoing Quality Assurance and Improvement. In some areas it has worked and practices have been able to co-ordinate activities. However many areas have collapsed, with no co-operation, and still more where 1 practice has become dominant in the cluster and others have either stood back to let 1 take all the pressure, or ‘power houses’ have developed. InScotland the framework is less proscribed, but I fear a more formalised or even forced structure will create definite winners and losers, and potential divisiveness in areas where very different practices are forced to combine services or organisational structures. And if ‘incentives’ or ‘penalties’ are then added, the downward spiral of power plays and manipulation are never far behind...

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  • Also, as Richard Vautrey is saying 'This builds on this contract and will not replace it. Nobody will have to give up their existing contract,'...I wonder if this is up for being voted on? I suspect from the wording that it is a major contract change brought in through the back door, and ground-floor GPs may not get their say on it, unless you fight. If this is not a ‘new contract’ there is no obligation to canvass the membership, only to inform...

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  • So what happens to the frontline GP surgeries who wish to get on with looking after their patients. Are they going to be penalised for not joining networks. GPC letting down the small and medium size practices?

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  • And what about areas in which the leadership of such networks have shown themselves to be self-serving, pocket-lining, system-toadying apparatchiks? GP federation led by NO GPs! Practices can recognise a pile of dung when they smell it and are disengaging. So what now?

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  • Is mandate another word for bully, and force.Bet it is that's all we have had for the las 14 years.

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  • Great effort to combine services to prevent the NHS from headaches on lonely last standing surgeries closing. But being too clever to save money the planners forget that they are just buying time- these new setup will sooner or later hit the cash crunch and will turn out more expensive but hopefully all books will have matched at the top. The question now is what happens when these networks also collapse - a bigger problem.

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  • That membership will be compulsory gives the game away.

    Here in Brum, our network p*** money and time away with abandon and little to show. The usual faces, most escaping the front line for coffee in biscuits and a chat, some manipulating advantage for their own Practice.

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  • This is just another step in setting primary care up for privatisation US style; using financial levers to coerce practices to work together or be financially penalised. Of course practices don't HAVE TO comply but then they lose any "major funding boost" that may be being waved about.
    This doesn't solve any of general practice's major problems.

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  • We'd love to do moer work, if all our clinical staff were not in empty EH week-end clinics, and if it were funded. If given a freer hand we've lots of ideas for admission reduction... but top down diktat is driven by soundbite demand schedule from senior politicos....however destructive twisting the service to provide them is!

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  • Anyone heard anything about the PM's £3.5Bn? I've not, not has the regional primary care director nor anyone in our CCG.

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  • Took Early Retirement

    A long time ago we had a short-lived thing called a PCG. We covered about 70,000 patients but it was forced into a larger PCT as it was "too small" we were told, and the buzzword was also "co-terminosity", so we lost out on that as we covered the area of two councils.


    Isn't someone just re-inventing the wheel here?

    Mind you, it might let a few more "Fugitives from the consultation" open their own magic casements onto a new world where they will be paid fairly generously for attending meetings and sending around email memos.

    Just like most (though not ALL) doctors on CCG boards, who were previously on PCT boards, etc.

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