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Independents' Day

GPs to be brought under hospital trusts' control under plans announced by Labour

Labour has announced plans for every hospital to become an ‘integrated care organisation’ with ‘GPs at the centre’, but GP leaders have warned this could lead to the ‘destruction of practices’.

Speaking at the Labour party conference in Manchester today, shadow health secretary Andy Burnham said he wanted hospitals to grow into the community and ‘into people’s homes’, providing an ‘end-to-end journey’ for patients.

This overhaul of hospital funding would be supported by the £2.5bn funding boost to the NHS.

But GP leaders have said that they are ‘extremely worried’ about the plans, warning they could lead to the ‘destruction of practices’.

The comments come after Mr Burnham revealed – in an interview with Pulse – that he wanted general practice to move towards being a salaried profession, with GPs working as employees of larger integrated care organisations.

He said he will move away from paying hospitals for their activity to funding them through a ‘year-of-care tariff’ that would see them being paid for whole pathways of care for individual patients.

He told delegates: ‘We will ask hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care – physical, mental and social. Why? Because it makes no sense to cut simple support in people’s homes only to spend thousands keeping them in hospital.’

Addressing ‘any family caring for someone with long-term needs’, Mr Burnham said there would be ‘one team’ around them, meaning ‘frail or vulnerable people’ should no longer be ‘shunted around the system’. Instead, he said, ‘this team will come to you’.

He added: ‘You and your carers will have one person to call to get help so no longer [going over] the same story over and over again. You will have a care plan personal to you and your family. If you and your carers get what you really need from the start, then it’s more likely to work.

‘Building the NHS around you will need a new generation of NHS staff, as Ed [Miliband] said yesterday. So we will recruit new teams of home care workers, physios, OTs, nurses, midwives, with GPs at the centre. And we will have mental health nurses and therapists at the heart of this team, no longer the poor relation on the fringes of the system but making parity a reality.’

But he added that Labour’s plans for whole-person care ‘will only work if the finances support what we are trying to do’, adding: ‘It doesn’t work if the finances are still about an episodic tariff, is about treating people in hospitals. The only reason why [Labour’s plan] has a chance is because from that consolidated fund at local level you can create a year-of-care tariff covering all of one person’s needs.

‘That is so important because then the incentive switches from treating people in hospital to supporting people in their home.’

Year-of-care schemes have been touted as the ultimate in ‘integrated care’ and been piloted by the current Government. During the conference, the Labour party has announced that it intends to set out a 10-year plan for Britain, including for how to fully integrated health and social care by joining up CCG budgets, social care budgets and the primary care budget held by NHS England into one single budget controlled by health and wellbeing boards.

However, Dr Richard Vautrey, deputy chair of the GPC, said GPs would be ‘extremely worried’ about the plans.

He said: ‘There are very few people who want yet another major re-organisation, which these plans seem to suggest. We would want to encourage greater co-operation and collaboration between health and social care organisations within an area, working with a common agenda and breaking down barriers between them and practices have a long history of working together and with others.

‘It was not necessary to undermine their contractor status to do this and, in many cases, they worked closely with social and other healthcare providers. This model of working should be built on, not undermined. We want to see community teams, including hospital specialists, built around the practice and this could deliver many of the aspirations articulated by Andy Burnham. However, GPs will be extremely worried about the creation of large organisations employing salaried GPs as this would lead to the destruction of practices, which patients value so highly.’

Readers' comments (53)

  • Sounds good in principle

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  • We have to remain independent. How will "patient choice" work if GPs sre employed by a hospital? How can we be a patient's advocate in that arrangement?

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  • why do you want to still be the be the patients advocate. Just be a good doctor to them. We have to stop being so paternalistic and others take on more responsibility.

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  • Not all sick people are capable of speaking out when delays or non-consultant decisions threaten their treatment. We know what should happen and have a duty to raise concerns when it doesn't. That's part of being a good doctor - not being paternalistic.

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  • Hard choice. Satan, mephisto, lucifer or Beelzebub. Which is the lesser evil! This would be a disaster as secondary care has no concept of how primary care works and would be swallowed up wholesale. GPs would be used akin to middle grade minions and loose all autonomy and status devaluing primary care. Can't see a role for CCGs either if t his happens. We seem to go from one extreme to another. Primary and secondary care power yo yo. Can we a please take healthcare away from the politicians PLEASE?

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  • why cant you be patients advocate if you work in the hospital?

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  • Actually I cant see any benefit to this. We all know hospital care inc outpatient costs more than GP probably because of all the free work we do so all this will do is cost more money and be less convenient for patients as you wont be round the corner any more youll be in hospital.

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  • oh yeah cos coughs and colds are the majority of our work. Don't the government realise that we do everything esp as they wont let us refer anyone on to secondary care anymore

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  • Why don't you announce dismantling NHSE for a start and taking over finances from the PCAs. The savings could go in billions. The lack of transparency and unequal funding is so stark that something should be done about this now. The pension role could be centrally transferred to NHSP and with access to annual statements for employees round the corner, I don't see why you need a whole battery of staff employed to deal with this. NHSE has been in destructive mode since it's inception - divesting power would be helpful.
    One thing Mr Burnham promised last night was 8000 new GPs - hmmm are you planning to grow them on the genetically modified fields because you really need them now and fast?
    One thing I'll accept is a salaried job with all it's comforts - but then don't expect GPs to work more than their stipulated Contract hours.

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  • Vinci Ho

    The danger here is 'skewed' definition of integrated care (as I always said nobody did manage to define that properly).
    There are three categories of problems we encounter in primary care every day
    1) primary care specific problems where no consultants are interested
    2) problems for swift referral to secondary care where time to reach a consultant is essential
    3) joint care between primary and secondary care

    The so called pathways matter the most only in (3). Bearing in mind , (1) is still the majority we are dealing with everyday . Indeed, if you work towards a healthier nation , the aim is to diminish the incidences of (2) and (3).
    Bottom line,it is about money and this model will go back to the traditional secondary care led health service once again.

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