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GPs buried under trusts' workload dump

McKinsey identifies need for 40% increase in GP funding

By Gareth Iacobucci

Exclusive: GPs in one of the poorest parts of the country are so underfunded through the global sum they need a 40% increase in their annual payments, a report by NHS external consultants has concluded.

Trailblazing PCT NHS Tower Hamlets has agreed a £12m-a-year increase in primary care spending after the report by McKinsey found its GPs were receiving only a fraction of the funding they needed to do their jobs effectively.

But the PCT, which has led the way in using external consultants to guide commissioning, has attached strings to the new money, with practices expected to work together as federations to manage patients with chronic illness.

Eventually GPs will become part of much bigger integrated care organisations, including secondary care, community care and social care providers, according to a PCT document, released to Pulse under the Freedom of Information Act.

NHS Tower Hamlets, which is seen as one of the leading trusts in the country and came second in World-Class Commissioning rankings, has modelled its plans partly on the Kaiser Permanente model in the US.

It will increase LES funding sixfold to nearly 40 participating practices to plug the identified gap, but though initially they will stay on GMS contracts, negotiations have begun to persuade them to switch to APMS.

Jane Milligan, director of primary care at the trust, said: ‘The clinical engagement of GPs has been critical to this work. It would be a shame if contracts ended up tying us up in knots.'

For participating practices, any LES payments related to long-term conditions will be shifted to the new formula from next April.

The report suggests a 70% increase in staff will be required to deliver packages of care for illnesses such as diabetes, hypertension, COPD and asthma, with more than 100 extra nurses potentially to be recruited.

Dr Kambiz Boomla, a GP in Tower Hamlets and chair of City and East London LMC, said the programme could easily be translated to other areas with high prevalence of long-term conditions.

‘It is an investment programme designed to take us above the level elsewhere. Our PCT actually had money to spend. The argument is, you get more health gain by spending it in primary care,' he said.

But he warned: ‘They have produced a very tight, performance-managed set of targets.'

GPs in Tower Hamlets need a 40% increase in annual payments, a McKinsey report concludes GPs in Tower Hamlets need a 40% increase in annual payments, a McKinsey report concludes How the extra money will be spent

• Care packages to be launched for diabetes, immunisations, hypertension, coronary heart disease, COPD, asthma, depression and CKD
• PCT to launch network of providers, starting with GP practices, which will eventually become fully integrated with secondary care, community care and social care providers
• Up to £12m increase in LES payments with aim to switch to APMS contracts
• Practices to get performance bonuses based on outcomes, patient experience, access and process performance

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