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GP practices to be stress-tested before being allowed onto new contract

GP practices will have to prove that they can ‘manage reasonable downside risks’ if they are to sign up to the new voluntary contract from April, NHS England has said.

A draft of the new 'MCP contract' - published today - says all GP practices will be tested by NHS England and NHS Improvement to decide whether they are financially stable enough to take on the new contract.

The voluntary contract will come into force in April 2017 for practices (or groups of practices) working in a 'new model of care' and for all others in groups of 30-50,000 patients in 2018. The aim is to bring 'a much broader range of services into the general practice model'.

It was announced by then Prime Minister David Cameron in 2015, who vowed to boost funding, banish the spectres of ‘box ticking and form filling’ and ensure patients had access to a seven-day service throught the new contract.

GP practices can sign up in a variety of ways, including a GP-owned company, a federation or as a joint venture between practices and a trust. GPs can also individually join an MCP as employees, with existing NHS bodies, like foundation trusts, holding the contract.

The draft confirms that the voluntary contracts will last for between 10 and 15 years, work to a whole population budget and with a gain/risk share for acute activity.' 

Community interest companies and NHS foundation trusts are also able to able to deliver an MCP.

Every provider that submits a bid for a contract will have to prove that they can ‘manage reasonable downside risks’ according to the draft. The level of financial security will be laid out in the form of an 'integrated support and assurance process (ISAP)' that will be run by NHS England and NHS Improvement. This will be drawn up by commissioners who will determine how financial risk to the MCP will be managed.


Readers' comments (11)

  • So in order to join we have to go through some kind of financial stress test? The last time I heard this was in relation to Banks. The difference is they had huge multibillion pound bailouts. All we have had is ongoing cuts, cuts and yet more cuts to finance and a huge increase in work load.

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  • So, is the proposal to go back to some form of fundholding i.e. to allow the relevant GP groups of 30,000 patients or more to hold a budget for everything and if the group reaches year end under budget they will be allowed to keep the under spend? Conversely if they go over budget they will have to pay for the excess themselves. That's where the financial stress risk would be. It could encourage innovation, but with the very low current combined CCG and NHSE budgets I can not see how a saving could be created.

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  • doctordog.

    I can think of scores of ways of cost cutting.
    The trouble is few of them are ethical.

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  • With current funding levels it would be impossible for any gms pms or apms practice to pass a financial stress test. If they do in order to push the new contracts through, there will be temporary sweeteners for the early few or token superficial stress tests which won't stop the new contracts from going under. The mcps will also destabilise and destroy existing practices before being destroyed themselves (or in some cases for preferred providers who are hospitals or multinationals large bailouts). The end result will be 4 or 5 large multinationals and lots of hospitals running primary care. GPC are failing to see the larger picture.

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  • I can envisage individual clinicians being penalised by the 'group' for ordering too many costly investigations / referring too many patients / prescribing costly medication / trying not to take on patients with costly chronic conditions (cancer, renal failure, patients receiving continuing care funding, all transplants, life long birth related learning difficulties...) The most costly problems were excluded in fund holding days - the budget for these was held centrally by the NHS. I presume there will be no NHS tariff. So there will be a downwards pressure on incomes, apart from those at board level, who will get any profit, if there is any. On reading the draft contract it implied that social services could be included as well!

    Even if a profit was made the DoH would still fail to uplift the budget(s), putting the finger screws on the groups for ever more productivity - the constant drive to balance the economy being the driving force

    There is no prospect of GDP rising and demand for care will continue to rise......does not sound like an industry I would want to join if starting out now

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  • National Hopeless Service

    Its takes just one patient with a heart-lung transplant and post op complications to financially destroy such entities. None of us went into GP to feel threatened by needed patient care.

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  • AlanAlmond

    I'm coming to the conclusion the adgenda is actually to get rid of the British form of general practice entirely. The plan is that in 10 years there won't be any GPs. There'll just be hospitals and 'primary care physicians' employed by them. It's curtains for the British model. Expensive that's what it will be. Madness.

    Some time around the early 1990's people in power fell in love with the idea of 'management consultants'. 'Smart' people educated at 'top' universities brought in to redesign the running of anything and everything. Having any kind of experience of the business involved was seen almost as an irrelevance ..being 'smart' was all that's needed. Firms like the now extinct Anderson consulting recruited ignorant young clever folk to remake everything. That's why so many of our countries utilities, infrastructure and public services are in such an appalling mess ..they've all been given the 'management consultant' make over by smart folk completely ignorant of the thing they're redesigning. These same arse wipes are in politics and running the health service ...we live in an age of management consulting mindlessness. Ignorance is as an asset. We can all be assured everything will continue to get worse. 'Smart' 'highly educated ' idiots are in charge.

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  • So, reading the new MCP contract (now online):
    1. no new money will be put into MCPs
    2. any set up costs will have to be borne by GPs
    3. no new money is promised to general practice in MCPs
    4. if MCPS deliver efficiencies they MAY be able to invest it in general practice (though in reality MCPs are unlikely to be allowed to keep significant profits, which are more likely to be clawed back by NHSE to support hospital debts)
    5. if MCPs fail to deliver, any losses will be borne by GPs: hence the need to stress test practices to make sure they can absorb potentially millions of pounds of debt.
    GPs get to pay out of their own pockets to form new organisational structures that are supposed to transform the NHS into a new form which can magically deliver huge efficiencies (which no-one else has managed despite far more resources) into a rapidly-collapsing and grossly underfunded system, whilst carrying huge personal financial risk.
    I cannot see any reason GPs would engage with this. This is Turkeys not just voting for Christmas, but also being told they have to pay for it out of their own pockets and organise it themselves.

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  • ...or being told to stuff themselves and peel the sprouts (sorry could not resist)

  • Look at the bottom line here: is the Healthcare Market awash with potential cost savings or financial opportunities that can be secured? No! If we throw social care in...the consensus is that it is billions underfunded. Measure this against the CQC expectations of delivery and you have a car-crash. If the govt truly wants this to work then "special money" will arrive if these pilots get into difficulty. Big risk. Personally, I think the NHS wants to call the GP's bluff about being able to run it better than they can. The plan goes something like: we fail, we discredit ourselves, they trumpet this in the media, and then we become minions in the branches of one or two multinational companies who will regard us as one of the more expensive employees, but not worth listening to ever again on any issues of service delivery or ethical provision of care. I think silencing the armchair politicians (GPs) is probability their biggest aim: they have no chance to redesign the NHS whilst GPs are lecturing their patients 40+ times a day. If MCPs succeed the NHS has lost was their idea, too.

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  • If you are being asked to sign a carte blanche regarding your ability to cope with the downside of the incoming contract, rest assured if there is an opportunity to bury you alive, this will be utilized by NHSE. In my case, even before I took over the Practice in 2010, they halved the MPIG when MPIG cuts were unheard of - the best part was that when I recently questioned the GP who took me on as a partner and was within 3 months of leaving, he was shocked as did not realize this had happened. You want corruption and intrigue, carry on signing what you are getting - or leave these Contracts for the big boys in CCGs and LMCs who most likely have inside information and can manage and handle any 'risk' - of which they certainly are aware at the time of signing while you aren't.

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