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Independents' Day

GPs to be employees of new integrated care organisations, under Labour plans to integrate care

GPs will be employed by new integrated care organisations set up in every area of the country, under the Labour party’s 10-year NHS plan for Government.

Setting out the details of the plan today, shadow health secretary Andy Burnham said there were currently ‘too many’ NHS organisations, but that Labour would provide the incentive for ‘all providers’ to ‘evolve’ into integrated care organisations (ICOs).

Under the plans, ‘young GPs’ would be encouraged to work for the ICOs as an alternative route to a GP partnership.

The ICOs will be set up in ‘every health economy’ and will be paid a single ‘Year of Care’ tariff to provide primary, secondary and social care to people deemed most at risk of hospitalisation.

Mr Burnham said he had originally envisaged hospitals taking the lead on forming ICOs - as he revealed in an interview with Pulse last year - but that he had accepted that there was not ‘one model of care’ and that they could be led by GP practices.

He added that the ICO will ‘hold the ring’ and provide a single point of contact for patients.

He added: ‘It no longer makes sense to focus solely on the viability of individual institutions, particularly where efforts to secure the finances of one could end up destabilising all around it.

‘The public spending outlook for the next 10 years brings a new reality. To compete in silos is a luxury we can no longer afford. The stark truth is that there are too many separate organisations with separate administrations.

‘There are savings to be made from reducing administrations in every health economy in England. We need to break down the silos and end those divides that hold us back: primary versus secondary care, physical versus mental health, NHS versus councils… [P]eople must leave loyalties to parts of the system behind and embrace a new shared loyalty to the local population.’

Speaking also at a roundtable attended by Pulse yesterday, Mr Burnham said the integrated care organisations caring for the most vulnerable people would employ ‘younger GPs at the start of their career’ and would ‘take a little bit of pressure off’ the rest of the GP workforce.

He said: ‘The most vulnerable patients could be cared for differently in a different model of care… that takes a little bit of the pressure off.

‘It’s also about saying that if younger GPs in the early part of their career want to work for an integrated care organisation then that is something that I think we would encourage. I met a group in Manchester recently who said: “We don’t want to become partners in a practice straight away, we want to work differently. We’d like a more salaried position to begin with and maybe go into partnership later on in our career”.’

And, speaking today, Mr Burnham indicated that these integrated care organisations is where Labour’s 8,000 new GPs would work, as he said the party would ‘create a ladder’ into NHS work via its ‘Time to Care’ £2.5bn NHS fund for young people wanting to work in the new system of integrated care.

Commenting on the plans, Professor Sir John Oldham, the GP leading Labour’s healthcare commission which reported last year, said in his view the plan did not need to signal the end of GP partnerships, but said that GP ‘corner shops’ would no longer be viable.

He said: ‘In terms of general practice and partnerships and where that goes, none of this interferes with what I see as the natural progression and debate that would go on anyway in general practice and primary care about what is the nature of our orgnisations to meet the future demands. My personal view is I think that the sort of things that [RCGP chair Dr] Maureen Baker has been talking about: federated structures, larger conglomerations of people sharing back-office functions, employing specialists themselves - rheumatologists, dermatologists, my own practice before we had a dermatologist there for 15 years, we did ultrasounds, we did ecocardiograms.

‘So I think there are huge exciting opportunities for general practice and primary care to occupy a space, should they wish to do so. What won’t work is not cooperating with people. What won’t work is deciding on having a corner shop mentality. That won’t work but working on a bigger scale will work. I think the future is a very exciting one for general practice. My career is in the past for that but I, in a sense, would love to start again.’

Readers' comments (38)

  • Another big steamimg pile of health policy is emmited from an orifice of a politician.Where are they going to get thes enthusiastic young GPs from?the same orifice.

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  • The words nail , final and coffin .......

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  • Tom Gillham

    A salaried job for an ICO doing heating checks and loneliness testing? I cannot think of a less appealing and more depressing job for an optimistic young GP at the beginning of their career.

    They don't want partnerships because they're finding their feet locuming or having a year in Australia. They enjoy the freedom and the readier cash.

    Unless the ICOGP jobs include a pay package well in advance of current salaried posts, and include regular secondments to somewhere hot and sunny, this is a woeful non-starter.

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  • So no top down reorganisation again then.

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  • Why are politicians mouths always open in photos ? Oh yes, that's because the only voice they're interested in listening to is their own. At least they're being up front about wanting to do a complete top-down NHS reorganisation again, ahead of the general election., unlike Tories last time round. Painfully obvious that Labour isn't going to be in government so I wouldn't get too stressed, my colleagues !!! They can say whatever they want, allow yourself an ironic laugh at their expense !

    Our federations are getting up and running and our main focus so far has been empowering individual practices to reject unfunded / inappropriate work, wherever it may come from - secondary care / private Consultants / allied health professionals / schools / employers / patients. The BMA / GPC workload document has actually been quite a help here.

    Being more militant and defending our core contract duties is actually easier than you may think.

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  • So, they take something that works and that patients like (small GP partnership model) but as it does not fit into their empire building and their need to keep changing everything, they make it more and more onerous, micromanaged, regulated, etc so that no-one wants to do it any more. Is John Oldham a practising GP?

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  • Why don't we contact the Govts of Australia, NZ and Canada to let them know there are highly qualified doctors available who might actually prefer to work there instead of some theoretical imaginary organizations i.e. private healthcare with lots of investment and shares held by british politicians.....

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  • All change.....but no change

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  • It no longer matters who is in power; Real health policy is generated from Whitehall and corporate lobby groups; The agenda has for many years been to strip GP's on independent contractor status and to make them salaried employees and now we are beginning to see the final stages of its implementation. Hence the erosion of autonomy and influence that has occurred over the past few years. Its merely a replication of the model of GOOD OLD FASHIONED BRITISH STATE DIRECTED SOCIALISM.

    conservative, labour, lib dem et al are irrelevant and this is why agendas are steamrolled through without thought and due process such as the LANSLEY shenanigans.

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  • Another nail in the coffin of the partnership model. Wave goodbye to the continuity of personal care that is the whole point of general practice.
    It takes 2 salaried GPs to see the number of patients I seen in a day as a partner - or would do if there were any to recruit. The impending retirement bulge of experienced partners will really cause the s*** to hit the fan.

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  • I'm an ST3 registrar. You could not pay me enough money to work for an ICO being bossed around by incompetent managers who care only about the budget. This will solve nothing and will be a disaster as no GP will ever work for one of these. Young GPs don't want partnerships because we don't want the commitment, or we want part time work, or we just don't know what we want. What we do know is the terrible time we all had working in hospitals prior to GP land and vowed never to return to it ever again.

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  • Vinci Ho

    For argument sake , if a young GPs is willing to be an employee of this ICO , how long will he/she stay at this level or status, forever?
    But by then, there may be no any other alternative. Perhaps go to become a Portfolio GP?

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  • I have just looked at Labour's 10 year NHS plan. It makes no comment about GPs being salaried to ICOs.

    Perhaps I missed but could someone identify where in the doc it says so that boldly?

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  • No Doctor will pick GP for a career. There will be a huge recruitment problem, far worse than now.

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  • There already is a recruitment crisis, even london doesnt have enough applicants for the posts

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  • Its a sad day when UKIP are making the most sense when talking about help policy.The lunatic have definately taken over the assylum and are runing amok.

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  • No one in politics appears to have the slightest idea what a GP is...or what they actually do in any real sense. I'm sorry but unless you know what a GP is and what they do cant design a service to make use of them.

    Its so sad because it's almost a done deal ..all of the political parties are basically proposing the dismantling and destruction of general practice as we know's not being debated in any real way in the media at's just happening. It's NOT what the people of this country want. The people of this country value their GP service highly but they are fed up they can't see them...and that's because the service has been clogged with politically motivated bureaucracy (e.g. QOF, CCGs) and starved of funding. The answer is to fund primary and social care adequately, have a proper debate about what the NHS is there for and stop sending such a disproportionate percentage of the NHS budget to hospitals...simply because it looks good on the telly.

    The country will miss it when it's gone...I certainly will when I'm old and need a GP.

    It's just so sad and so short sighted.

    Potential Drs be aware ...this is not a country in which to train and work as GP.

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  • @10:05pm "this is not a country in which to train and work as a GP"

    Agree with you on the latter- working in the UK is a complete and utter waste of time. However the good thing about the training you receive in the UK is it's value outside of the UK!!

    Having moved abroad a few years ago when I could see this madness developing I can attest to the fact that British trained doctors are in high demand worldwide!

    We live in a global village and the NHS has to compete with all these other wonderful places to retain your loyalty and commitment!! If they are unable to achieve this it's no loss to any of you, but it is to them!!

    I would say to any trainee or GP stuck in a rut right now over there in the wonderful happy sunny UK (!!) the world is your oyster, if they don't want you there's plenty of places out there that do!

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  • Can no Politician understand that successful health care will only work when Doctors are allowed to pick their colleagues. All successful working revolves around happy teams

    All Politicians have to do is to allow teams to develop within the constraints of good clinical outcomes.

    Forcing clinicians to become employees of large corporate organisations, whether owned and controlled by Local Authorities, Big Business, GP Federations or Foundation Trusts will NEVER deliver good outcomes.

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  • andrew Field

    I look forward to seeing the incentivising package that will make me do all the extra work I do now as a partner when I'm salaried. #pieinthesky

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  • "No one in politics appears to have the slightest idea what a GP is...or what they actually do in any real sense"

    I quite agree - there does seem to be general ignorance on this front, coupled with complete lack of insight that this might possibly be the case making it all the more damaging.

    Less arrogance and more willingness to listen to real GPs and their patients before imposing "solutions" wouldn't go amiss.

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  • So GPs employed on significantly reduces wages, reporting to. 'Manager' with a 2:2 from hull polytechnic. Bye bye NHS- now you can understand why I'm emigrating in April.

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  • Una Coales. Retired NHS GP.

    Not on your Nelly!

    Straight after GP training, I stepped into a £100k job working as a salaried employee of a private healthcare firm. I thought I had struck gold! £100k for a 40 hour work week! Until the reality sinks in. Patients were booked round the clock between 8 and 12 and 1 and 5. I asked the manager when I would be allocated time to do the admin work? She replied during lunch, before or after work? The one hour lunch break was used by me to do all the admin work, checking blood test results, investigations, dictating consultations and letters. The private company did not have NHS computers with EMIS web software so everything had to be done by hand. Handfilling forms. Hand-writing notes. And the GP was also nurse, phlebotomist and technician, doing the ECG tracing, spirometry, eye testing checks like an optometrist, taking blood, labelling tubes and forms, etc.

    There was no time for loo breaks and lunch meant scoffing food in 5 minutes to then be able to speed through the admin.

    As I peered at other doctors' schedules, I noted one doctor who was favoured by the senior receptionist and his schedule had breaks after each patient. In other words, his workload was half mine for the same pay!

    Needless to say working at full speed 5 days a week was NOT worth the £100k minus tax, minus MDO fees, minus GMC fees, etc. One private banker client said to me, 'they must be paying you a lot of money to do this mundane job.' I quit that week!

    Scroll back another 20 years to when I was a US medical student shadowing 2 family physician employees of a health maintenance org (Kaiser). One was a young enthusiastic female FP and the other a much older English male FP who rarely smiled. He had already rounded on his in-patients before I met up with him for his 8 am outpatient Kaiser clinic. I saw a lady with a fever and cough and he examined her and sent her for an in house cxr. Within an hour, she was diagnosed with pneumonia and admitted. Kaiser arranged transportation to take her to the nearby Kaiser hospital. I then shadowed the young female FP in her huge plush office. I asked how much she was paid. She was surprised at my abruptness but acquiesced and replied $70,000. I made a mental note to myself that surgery was definitely my career of choice! She taught me how to put my hair in a professional bun and took me out to lunch. She was young, enthusiastic and single. We came back to another clinic and then she went off to round on her in-patients while I left for the day.

    This is what may lie in wait for you as a salaried employee of an integrated care org, HMO, or private healthcare firm. Or you can relearn how to be an independent practitioner by joining the Independent doctors federation which was set up as an alternative to the Royal College, accepts semiprivate GPs/consultants and helps each other thrive and set up independent practices.

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  • Una Coales. Retired NHS GP.

    And at an IDF function, I met a young female European GP, who didn't bother with the hoops to join a NHS Performer's List, did not have MRCGP and instead joined a private GP practice, working at a leisurely pace, 20 minute consultations and being able to offer her patients consultant referrals within 1-2 days and same day or next day imaging. She didn't have to worry about billing as the receptionist took credit card payments much like a hotel.

    Copayments would have allowed state patients to also benefit from first class private treatment at a fraction of the cost, ie subsidized by the government. Alas the government seems to prefer to leave the poor and elderly out in the cold with an all or nothing system of private healthcare and no copayments.

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  • I think there is some sense in the plan but would agree any top down reorg is to be avoided at all costs, and that the 'young GP in ICOs' notion is somewhat fanciful.
    Perhaps a better way of getting to the ICO model is to re-task CCGs to be the executives of integrated health systems, commissioned by HWBs on, say, a 10-year contract.

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  • Perhaps a better way of achieving a functional and sustainable GP service is to ask GPs what is needed and to ask prospective GPs what would tempt them to continue. In addition, politicians need to be clear and honest about what their think-tank-derived forced changes would mean for patients and allow discussion over whether to support the current system or push ahead with its destruction.

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  • Out of 80 medical students only 8 showed any interest in gp . Not enough for this ambitious scheme

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  • Nobody picks medicine as a career to be micromanaged and treated with abuse from all sides - excessive workload and multiple jeopardy complaint organisations, with incomes and pensions constantly being reduced.

    Medicine is already becoming far less popular as a choice for undergraduates

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  • I'm a patient as well as a GP; I like and trust my corner-shop GP and will not be bullied into changing to an anonymous megapractice, however many shiny machines they have.

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  • Spencer Nicholson

    i thought this was on the cards 15 yrs ago, it is the logical progression of Labour health policy of the early Blair years to merge PCT's, hospital/foundation trusts and social services to deliver an all encompassing care organisation that coordinates all facets of care but under political control of the local authority as Labour has a central control and command obsession, Stalin only went in for 5 year plans.

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  • Good Grief, why does Burnham even get airtime? Stafford PFI and now the most inefficient part of the service running the most efficient part. The more is hear all these jokers the more I realise that no policy is the best policy let us get on with it

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  • I find it interesting that week in week out GP's post comments stating that the current system doesn’t work because there's not enough money and too much to do yet they slate EVERY singly idea proposed by an politician?

    The H&SC Bill was clearly the biggest mistake ever and that is evident by the fact that the structure is slowly moving back to exactly what it was. With commissioning going back to CCG’s and Area teams merging it won’t be long before we effectively have PCTs and SHA’s again! However, that won’t change the fact that the current model of primary care doesn’t work. Yes it needs more money but it also needs to change and it would be interesting to hear how GPs think it should change rather than just belittling every idea put in front of them. Clearly Andy Burnham has spoken to GPs however it is highly unlikely that every GP in the country is going to agree. Surely the BMA should be involved in any redesign of primary care and I’d also really like to hear their views because for me they are way too quiet!

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  • If it means the end of CCGs, I am all for it

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  • Anonymous | NHS Manager | 29 January 2015 8:47am

    if you have been reading the posts week in week out then i'm surprised you missed some of the ideas suggested.

    they have included;

    1. models based on australian, new zealand, other european states care

    2. moves to our dental colleagues model

    3. insurance backed schemes

    4. mass movement to small independent GP owned / run private practices

    5. charging patients and so on

    problem is that BMA, rcgp have eggs all in one basket and continue the 'NHS' only mantra and refuse to look into other models of care. they would rather sacrifice the profession than the NHS. I would agree in the NHS model if it wasn't for the daily abuses of the system that I see. The failure is assuming everyone who walks through the door is vulnerable and has a clinical problem, over medicalisation of society, lack of support when we say no to malingerers, worried well. I could go on but until the 'leadership' acknowledge the flaws in the NHS we are getting no where.

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  • Anonymous | NHS Manager | 29 January 2015 8:47am

    Because every idea is stupid so far..... if he really listened to GPs, he would be talking what we want: reduced regulation, reduce public demand, not push for increased access or targets, reduce paperwork, reduce non-clinical responsibilities, trust us with good funding to be able to use it appropriately, appreciate that what we do is worth far more than being salaried employess of ICOs, alternative models of care include copayments from patients, etc. do you see any of that? no. do you see any GP wanting to be salaried employee of ICO? maybe clare gerada only.

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  • ... in short politicians have failed to tackle 'demand' and 'supply' but are looking to deal with growing demand with fallling resources whilst improving quality. I know of no business in history that has done this.

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  • Anonymous | Salaried GP | 29 January 2015 10:32am

    totally agree.... "I would agree in the NHS model if it wasn't for the daily abuses of the system". Only patients who really need to see a GP should be allowed to see a gp. Surely a potential solution could be a strict triage process? Those who are simply seeing a gp because they're lonely or have other minor issues could be referred to the ICO or something else more suitable to meet their needs other than wasting valuable GP time?

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