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CAMHS won't see you now

Hospital trusts start drive to set up GP practices

Exclusive Management consultants have held seminars with several hospital trusts about setting up new GP practices as outlined in NHS England’s five-year plan, and have told Pulse they have seen a ‘huge appetite’ for the move.

PwC have been holding the seminars following NHS England’s Five Year Forward View, which outlined new ‘primary and acute care services’ (PACS) that would allow hospital trusts to use their surpluses to set up GP practices with their own registered list for the first time.

NHS England said the move would better integrate care, but GP leaders have warned a landgrab by hospital trusts would hold risks for GPs as it would allow trusts to ‘take over the world’.

Pulse has learned that PwC has observed an ‘extraordinary level of interest’ among trusts in setting up GP practices, as they could benefit from it financially and prevent the current drain of funds due to early discharge and community care schemes.

NHS England’s five-year view – which has since received Government backing via a £200m ‘transformation fund’ to begin the work in 2015 – puts forward two competing models of primary care, with GP practices setting up multiple community providers (MCPs) that would integrate more closely with secondary care, mental health services and community services – and hospitals setting up GP providers under PACS.

NHS England said PACS would only be allowed in areas where general practice is ‘under strain’, but could eventually become the equivalent of the ‘accountable care organisations’ in the US, which have responsibility for all patient care under a capitated budget.

Dr Tim Wilson, a partner in the PwC health sector team, told Pulse that trusts were seeing the financial opportunities in taking on GP practice lists: ‘For many hospitals looking down the barrels of a deficit, this gives them an option to do some good work and benefit from it financially.’

Dr Wilson said that PwC had begun holding meetings for potential providers of both models, saying that NHS England’s plans had ‘tapped into the zeitgeist of the NHS’.

He said: ‘PwC has held meetings for organisations interested in the PACS and MCP models of care… Holding these meetings was a natural next step for organisations interested in providing better outcomes for patients in a more sustainable fashion, to help them work out what it is they need to do next. This is not going to be easy, and there is a lot for them to think through, not least of all, which model (PACS or MCP) their system should be exploring.

‘There is an extraordinary level of interest amongst providers and commissioners in these new models. I think the Five Year Forward View has tapped into the zeitgeist of the NHS, and indeed social care. I think when these models were promoted people were saying “yes, that is exactly it, what we have been wanting for the last few years”. There is a huge appetite from trusts, GPs, social workers, community providers and commissioners.’

Recalling a conversation with a trust chief executive client, Dr Wilson said: ‘He has a vertically integrated organisation in that he has a hospital integrated with community services, and he said “the problem I’ve got is that we’re getting better and better at looking after older people, I’ve got a team going round A&E, they spot the older people and they stop them going into hospital, they go in and are able to get them out early, but every time I do that I lose money”. He wants to be a PACS for the money to work more to be able to do more preventative work.’

Dr Wilson said he thought these new models would be going live within two or three years. He said: ‘It is likely to be a couple of years before these organisations are actually in existence from an actual formal point of view, they are two or maybe three years out. However, we envisage that there will be quite a lot of improvement in care delivery along this route, I think patients will actually start to experience improvement within six months.’

But NHS Alliance chair Dr Michael Dixon said there were dangers connected to the PACS model. He said; ‘There’s a real danger that the outcome of a hospital-dominated, secondary-care dominated model is that general practice become largely salaried, with GPs losing their status as independent contractors.

‘With very large hospital trusts, there’s a danger that GPs would become the front-line drones, rather than being at the centre of the system.

‘My fear is that some hospitals will see this as an opportunity to take over the world. There would be good reasons for hospitals to take on general practice: they could make sure that local practices only referred to that hospital, and they could also bump up their income. The danger is that this will create further flow of money into secondary care away from primary care.’

The news comes as former RCGP chair Professor Clare Gerada, who is now an NHS England (London) adviser, has predicted that there will be no more GP partnerships in London within a decade.

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Readers' comments (29)

  • I agree with the conflict of interests. For example we do a fair bit of minor surgery - as part of our LES.

    If I ran a hospital and GP surgery together and needed to do some minor surgery, would it be better to choose the 40 pound LES or the 200 pound tariff?
    Same applies to joint injections.
    And most importantly to emergency cases - I will see 10 or so extras a day - could I charge an emergency department attendance tariff for each one?

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  • To quote from the article,

    "...... I’ve got a team going round A&E, they spot the older people and they stop them going into hospital, they go in and are able to get them out early, but every time I do that I lose money”

    So they know there is CoI. Does it stop them? I'm afraid the public will see a whole new health system when this happens, driven primary for profits, not patient care.

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  • It beggars belief. Primary care has been systematically deprived of funding for development for a decade, while successive governments have thrown money at hospitals. Our local trust is one of the most indebted in the country and seem unable to find their way out of their continued inefficiency. The thought of them making as big a hames of primary care, not their area of expertise, as they have of hospital care fills me with despair. Once agin the planing is lead by highly paid bean counters on high salaries who have no comprehension of the clinical and social realities.

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  • Where is/was Dr.Wilson a GP,as is mentioned by PwC?

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  • Took Early Retirement

    yes, Brill idea!

    Patient says, "I keep coming over all funny" Doctor says, "Gosh- you might be having a stroke, you can't be too careful, let's take you 50 feet round the corner to ED."

    £120 to the acute trust from the CCG's budget.

    As others have said, the conflict of interest is so vast, only a cretin at the Doh! could not see it!

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  • 90% consultations in primary care....Jesus imagine the parking! My patients complain bitterly at the lack of it and it's free......

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  • You need 4A* to be a doctor 2A and a B to be an accountant. Management Consultants do not have to very clever, but they are more astute.
    The 2A+B is earning £4000 a day, compared to 4A* 250. Guess who is truly clever.

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  • Vinci Ho

    (1) Nobody is surprised once Harvey Dent pressed the button of his 5YsP. Whether is MsCP or PACS , it can never run away from the question of how funding is guaranteed? Harvey Dent is not the Chancellor and even the Chancellor of a government on its way out had promised more money,it is only a promise.
    (2) Perhaps it is not a bad idea to let secondary care to understand the real time flesh and blood of general practice . Some people may even need to come out of their ivory towers to work with GPs
    (3) Then of course , it is the wonderful question,' where do you get more GPs?' The day Agent Hunt said he was not picking a fight with GPs , he had already declared war on us. Now many had left, the one staying behind are very sceptical and the young ones are bemused , reluctant to join. Who are the sinners?
    (4) Yes,I would expect some colleagues might want to work for hospital or consultants as salaried GPs but this is NOT the same case as GPs with Special Interests , GPWSI in the past. It is about them supervising GPs to carry out everyday business. And then we had Professor Thomas said he said about GPs , which certainly will not help .
    (4) It is a circle of life, what goes around, what comes around. At one time , we had PMS, APMS, PCTMS high up in the air because politicians and bureaucrats simply do not believe in what we have been doing.
    (5) So bring it on , MsCP , PACS or even more. The history will judge you all.

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  • Encroach onto primary care and ccgs should stop any bailouts. Simple as that. Secondary care can't have its cake and eat it.

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  • Ooh! Hospitals think they can make money out of providing primary care! I'd like to see them try - but then again maybe not. ATOS and United Health pulled out of trying to provide GP services because they couldn't make a profit. At £20/consultation I don't see how hospitals will either. If they are seeing this as a money making exercise they have failed the first test that would have made me think such link-up was desirable. They have shown they don't really have a clue about primary care. As for PwC cashing in on advising about these new structure - from what was in the news recently about them giving "free" advice to policy makers in government and in the opposition parties, PwC probably invented these new "structures" that appeared in the 5 year forward plan.

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