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Stevens: We must consider alternatives to list-based general practice

The practice-list based model of general practice could be replaced in future under plans for reorganising primary care, the head of the NHS in England has told a conference of academic GPs.

NHS England chief Simon Stevens said there were benefits of having care planned around defined patient lists, but added the changing needs of the population meant ‘other ways of interacting with primary care’ were essential.

Although Mr Stevens did not explain what other models could be used, he said a move away from practice lists was ‘happening’, and asked whether we should ‘close our mind’ to such changes.

It comes after the LMCs Conference voted in favour of moving to payments based on activity, rather than list sizes.

But the GPC warned that the NHS will move away from registered lists ‘at its peril’.

The NHS England Five Year Forward View released last year set up new models of care that encompass primary and secondary care, including GP practices employing consultants and hospitals employing GPs and taking on practice lists themselves.

However, Mr Stevens told a packed lecture theatre at the annual meeting of the Society of Academic Primary Care (SAPC) that there was going to be a move away from practice lists.

He told delegates: ‘Do we believe the idea of practice lists… has to be the only way in which general medical services are delivered, or are we going to see other ways of interacting with primary care that go beyond that?’

He added: ‘I’m fully aware of all of the things we’ve got to be careful about there, the benefit of defined lists, the benefit of the patient population from where you can plan and set resource limits, but this stuff is going to be happening.

‘Do we close our minds to it or do we say in some cases that is something we should embrace? I think that is a question we will be forced to confront.’

However, the GPC said that undermining the general practice registered list would put the whole NHS at risk.

Dr Richard Vautrey, deputy chair of the GPC, said that the Five Year Forward View itself stated that ‘general practice with its registered list and everyone having access to a family doctor is one of the great strengths of the NHS’.

Dr Vautrey added: ‘The NHS moves away from this principle and solid foundation at its peril.’

He said that the ‘inherent flexibility and adaptability of general practice can and does meet the needs of the variety of different populations’, but added that it needs to be funded properly to achieve this.

Dr Vautrey added: ‘This is the fundamental issue that needs to be tackled, particularly to ensure practices serving the needs of atypical populations or areas can be properly supported to deliver good general practice in a viable way.’

At the conference, Mr Stevens’ described his plans for the ‘radical’ reworking of primary care under the Five Year Forward View, underscoring his commitment to breaking down the barriers between general practice and specialist clinics with the development of ‘new models’ of care.

He also restated his belief there needs to be a greater emphasis on a whole team-based approach to primary care - including the introduction of practice-based pharmacists into general practice that was announced earlier this week.

Mr Stevens said he would be ‘staggered’ if the forthcoming Government commissioned workforce review - currently being prepared by Professor Martin Roland, professor of primary care research at the University of Cambridge - did not include this recommendation.

Readers' comments (57)

  • Payment by activity. Like the dentist, Australia and the rest of world. That works best and needs to happen. GP's might actually be paid what they are worth finally. Also, just like Australia, more payment per patient to be seen at their convenience (evenings and weekends) possibly part funded by the patient!

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  • yup - i'm looking at alternatives right now - full time locum vs. emigrating vs career change vs, working full time private.

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  • So let's just abandon all continuity of care. No conflict of interest here then...

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  • Payment by activity would create competition between practices. This would improve patient access. It would take time for GPs to get used to not having the full notes of a patient. Having worked in Canada this was the norm for all GPs. One just adapts like everything else in life. If adopted here they could be huge swings in profits from one practice to another and on an on-going basis.

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  • Be prepared to be screwed over and sidelined

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  • If you don't do individual capitated payments there are only two other options:
    1) Payment by results- not going to happen
    2) Outcomes based contracts via Accountable Care Organisations
    Ergo he wants rid of ICS.

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  • Actually payment by results / activity could happen.

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  • Alles klar . The establishment want the partnership model out of the way . This is why general practice is allowed to collapse , next stage salaried work drones then privatisation . We're fucked -bail out now !

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  • Payment by activity -dream on. It won't happen because it's too expensive .

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  • Radical reworking can be translated as the total shafting of primary care .

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