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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'.

 

Readers' comments (33)

  • 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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