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At the heart of general practice since 1960

GP practices offer to run care homes and discharge services as NHS England's general practice overhaul begins

Exclusive GP practices across the country have seized the opportunity to apply for £200m of new funding from NHS England, with radical plans to expand into running care homes, day centres and hospitals.

Pulse can reveal the details of several bids submitted by GP practices by the deadline yesterday focus on expanding further into community and secondary care services, and providing better discharge support.

One group of practices hope to cover some 70,000 patients with plans to take over a small community hospital.

Another plans to cover 53,000 patients and build a care home and a day centre for elderly patients.

Successful bids will see practices gaining ‘vanguard status’ and being allocated a chunk of the Government’s one-off £200 million fund aimed at ‘kickstarting’ the new models of general practice described in NHS England’s Five Year Forward View.

The document urged GP practices to consider becoming ‘multispeciality community providers’ that would allow them to combine with other community services, hospital specialists, mental health and social care ‘to create integrated out-of-hospital care’.

The Whitstable Medical Practice in Kent is teaming up with two smaller nearby practices into a federation covering 53,000 patients to apply to become one of the chosen pilot sites. It is planning to use any money allocated to set up a new community hospital, a nursing home and an ‘extra care facility’ for frail elderly people that will include a day centre.

Dr John Ribchester, a partner at the practice and a member of the governing body of NHS Canterbury and Coastal CCG, said: ‘The whole concept is to try to produce an end to silo working and a much more connected health and social care offering for the population that the three practices serve.’

In Wessex, LMC chair Dr Nigel Watson is a partner at one of seven GP practices that are teaming up with a small community hospital to set up an extended service to some 70,000 patients, including the frail elderly, mental health, and older people’s mental health.

Dr Watson said: ‘Working with the voluntary sector and the local authority [will] also make general practice more sustainable in the long term, to produce a better career structure for young GPs, retain older GPs, and make better use of people’s skills – but [also] maintaining the strength of the registered list and general practice as it sits today.’

 

He added: ‘There is lots of interest in developing this and seeing as a way forward potentially to get new resources to help outside hospital care. I know of at least five other bids in Wessex that are being talked about.’

Middleton GP Dr Mohammed Jiva, secretary of Rochdale and Bury LMC, said they were looking carefully at the interface between primary and secondary care. He said: ‘We’re looking at early discharge schemes - in terms of helping patients get out of hospital sooner and trying to avoid admissions from A&E in the first place.

‘It would do a couple of things: one, it would allow discharge of patients earlier, knowing that there is a system in place in the community to look after the tail end of their care, which frees up a hospital bed, allowing those that need to be in hospital to get admitted.

‘Secondly, it would also ensure that what goes to A&E and is assessed and managed by A&E is appropriate - and that what isn’t appropriate is referred back into the community with a GP appointment. So there’s a big element of patient education and knowing what services are available locally, and that A&E isn’t the first port of call for minor ailments.’

Elsewhere, NHS Dudley CCG said it has made an application that would see GP-led MCPs of integrated services across health and social care created to serve 60,000 patients, as part of ‘a wider network of care’ operating at a population level of around 300,000. A spokesperson it is ‘establishing the mechanism for commissioning best practice pathways of care for treatments that can’t be undertaken from within the core model of provision’.

NHS Hardwick CCG has also applied to become a pilot site, with a bid including 16 member practices with a combined patient base of 102,000 people, that will provide extended primary care via community hubs.

The applications come as hospitals prepare to make inroads into primary care. Pulse revealed last week that hospitals were already recruiting GPs to join them and prepare to become the ‘primary and acute care systems’ also described in the Five Year Forward View.  

NHS England declined to comment on how many applications it has so far received.

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Readers' comments (20)

  • I wouldn't touch a care home with a barge pole.When i was a partner we would be inundated with daily visit requests by staff playing defensively and demanding relatives always complaining that whatever we did was never enough.The workload generated was just too much and we decided not to continue with the local care home LES.

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  • Simple, joint a practice that does not look after care home. The extra money definitely not worth the time or money.

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  • I despair at the mess general practice is in. It is truly a nightmare from which I see no way out. I wish I had never darkened its door

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  • We should all be wearing our underwear on the out side of our clothes with a cape and x ray specs.it seem they want GP land to fill in all the holes that is the crumbling of the NHS.Newsflash, we will not save the NHS from the demographic timebomb which is happening now,sooner or later the whole edifice will collapse in a big fragmented messy pile.To little to late idiot politicians(at in government and in our organisations).

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  • A positive article. Really good to see some in the world of primary care aiming to take on additional responsibilities and pathways with the expectation this will improve services for patients. It will be interesting to see how some different models could make a difference to outcomes, reduce variation and hopefully, improve the working lives of those in primary care.

    And what a shame we have the usual negativity on the Pulse comments. And then we wonder why trainees may not wish to join general practice. It would be nice to sign with my name but can't abide the hassle. JW Greater Manchester

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  • A GP’s job today is a 50+ hour a week occupation with no stretch. Adding in Nursing Home and Secondary Care patients just cannot happen. More bodies are needed. They aren’t around and there are few in the pipeline. So how in hell’s name is this going to work?

    Mr. Gobby Politician what would you like me to stop doing? Seeing people who are ill? People who have their chronic disease being monitored? People’s prescriptions? People’s referrals? Whatever it is patients will suffer and maybe die.

    By all means have a Hospital based Interim Care Physician whose job it is to do this. They would need to be skilled and would not be cheap. But then the point of this is to save money isn’t it? That’s why GPs, whose job seems to expand like Twizzle (Google him), can do it for minimal cost.

    Except this time they can’t.

    COI Ex Co-op Manager.

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  • On the face of it, if properly resourced, this could be a good thing.
    The danger is that the "fat cat GP" agenda and potential conflict of interest brigade make it impossible.

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  • It is interesting how this is a wonderful idea from a managerial perspective i.e. high productivity,low cost. Not so wonderful for the provider in the long term.Another case of doctors feeling for their wallets as per Kenneth Clark.

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  • Does the NHS manager really think we are short of responsibilities? Might explain much if that view is the widely held managerial one.

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  • No, this NHS Manager does not think you are short of responsibilities. I know you have enormous responsibilities which are on the whole, shouldered brilliantly with care and dedication. I think the service is stretched to breaking point, staff in all disciplines in general practice are being battered by workloads and are struggling to see a way forward to improve the care offered for future populations and also for how working lives can improve.

    What is so frustrating is knowing that GPs and their staff are the answer but all one gets in Pulse comments is constant harping about how life is dreadful but no get-up-and-go to resolve. We (collectively - clinical staff and admin staff including managers are, amazingly, all striving for the same thing) need to be provided with the mechanisms, support and the space to think about how services can be different to meet the needs of all of us in the future. This article shows some interesting thoughts about how this could be done. Some may work and some others may not - but surely trying to work out better ways of doing things is a good thing.

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