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Gold, incentives and meh

Nine hospitals given green light to provide GP services

Nine hospitals have been given part of the £200m funding to provide integrated primary, secondary and social care, which will allow them to appoint GPs, NHS England has announced.

The approval of the ‘vanguard’ projects - which also include 14 GP-led bids - marks the next major stage in the implementation of NHS chief executive Simon Stevens’ Five-Year Forward View.

NHS England said that there were 269 applications from groups of nurses, doctors and other health and social care staff.

In all, 29 bids were approved, including six bids by care homes.

The two main new models of care – the GP-led ‘multi-specialty community providers’ (MCPs) and the hospital-led ‘primary and acute care systems’ (PACS) – were included as part of NHS England’s Five-Year Forward View.

It had said that MCPs will be the more common new model, with PACS only established in areas of poor GP recruitment. But nine of the 29 bids approved were from hospital-led organisations.

The new models will employ a mix of primary and secondary care staff to deal with commonly encountered conditions such as diabetes, dementia and mental illness. Some will see some employing ‘social prescribing teams’ who will be able to refer patients to voluntary organisations and local authority services.

Pulse has previously revealed that several hospitals are well advanced in their planning, including one already advertising for £100k GP vacancies.

NHS England has said that both new models of care will be funded on a patient list basis ‘and other forms of funding’.

A statement by NHS England said: ‘It is estimated more than five million patients will benefit, just from this first wave. For example, this could mean: fewer trips to hospitals as cancer and dementia specialists and GPs work in new teams; a single point of access for family doctors, community nurses, social and mental health services; and access to tests, dialysis or chemotherapy much closer to home.’

Sir Sam Everington, chair of NHS Tower Hamlets CCG and NHS England national GP adviser, said that the successful bid in Tower Hamlets includes the 36 practices in the London borough.

He told Pulse: ‘One of the key parts of our model is social prescribing. Fundamentally this means from a GP’s desktop you can refer to a social prescribing team. You might suggest the jobs adviser or the health trainer, or someone to help you with your weight. Or it might just be “my patient has got this problem – can you help?”.

‘The team will then connect the patient to potentially 1,100 voluntary organisations, the local gym or a whole raft of support systems.’

GPC chair Dr Chaand Nagpaul said that if implemented properly and led by clinicians, ‘these models have the potential to break down disruptive organisational barriers between GP, hospital and community services’.

However, he added: ‘To achieve its aims, these proposals must… address the long term under resourcing of general practice as well as ensure that resources shift into the community to provide the expanded volume of care moving out of hospitals.  It is also vital that these changes maintain the essential strengths of the personalised care provided by GPs to registered lists of patients.’

What various new models are doing


Multispeciality community providers (MCPs)


Tower Hamlets ‘Integrated Provider Partnership’

This project aims to build social, primary, community and acute care around the patient – offering them a ‘single shared assessment and plan’.

Derbyshire Community Health Services NHS Foundation Trust

This vanguard will develop a prevention team of GPs, advance nurse practitioners and mental health nurses, with extended care and therapy support to offer more care for people in the community. This includes a ‘focus on extending access to GP services’ and sharing GP records with A&E and Out of Hours computer systems.

Vitality (Birmingham)

GP partnership led project, offering care based around the GP with a care co-ordinator to support patients accessing care from across the range of social, mental, community and enhance secondary care services. Will include increased provision of community outpatient and diagnostic services.


Primary and Acute Care Systems (PACS)


Yeovil District Hospital NHS Foundation Trust ‘Integrated Primary and Acute Care System’

This bid involves a single budget for primary and secondary care, with patients given a care co-ordinator and a single personalised care plan, with ‘senior medical input’. GPs, hospital consultants, community staff and social workers will work as a single team to ‘share information about patient care needs, and deliver a more integrated set of services’.

Northumbria Healthcare NHS Trust   

Hospital-led  project involves redesign of community and acute services to create primary care ‘hubs’ offering seven-day appointments, with patients able to access their GP over the weekend to stop them going to emergency services. Model will have fully coordinated hospital discharge and shared IT functions.


Enhanced care home care


East and North Hertforshire CCG

A dedicated multidisciplinary teams including GPs, community psychiatric nurses, district nurses and geriatricians will work with care homes to support patients proactively, as well as when patients deteriorate. Will also develop a ‘rapid response’ service able to deploy community nurses, matrons, therapists and home carers within 90 minutes.


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Readers' comments (22)

  • Do GP's in PAC's areas have (even more) cause for concern?

    Seems to me to be a takeover of sorts.

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  • £200 million seems to be spread quite thinly.

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  • bring it on.

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  • This is a very good idea. But, I would go a step further and look also at prescribing and "scrapping" of QOF.
    In our society, with the increase in longevity we have assisted to an increase of the problems related to the elderly , in particular the polypathology/morbidity and, simultaneously , the polypharmacy . This situation leads to risks of drug interactions , poor adherence , confusion , cost , side effects . For this it is important to first consider the problem of the real needs of the elderly patient to take each of the prescribed drugs , in relation , for example , to life expectancy . I would very much welcome a study looking at the clinical outcomes adjusted for quality of life in the over 75.

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  • 100k salaried role with an FT
    -job plan
    -set hours
    -MDU subs paid/Crown indemnity
    - Employers pension contribution
    -easy access to secondary care colleagues/ix
    -god forbid joint working with secondary care and maybe even a social life ;-)
    -Study leave?
    -Potential career progression within a bigger organisation

    The grass is not always greener but maybe a touch less can see the attraction especially to our younger GP trainees , no running a small business at lunch time with ever decreasing funding and increasing number of hoops, HR, recruitment, contracts, CQC visits, buying into a partnership etc etc
    Even lucky GP partners on 150-200k per year- do the sums , do your hourly rate, look at the medical risk, financial risk etc

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  • NHS is lost.

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  • This is about GPs leading the way, being heavily involved in actually managing the care they provide rather than being micromanaged by DoH or NHSE.
    The amount of negative energy on here is truly depressing, like dementors sapping one's energy. If the NHS is in such dire straits don't give up on it, be involved, help it survive, resist all the negativity aimed at us.... GPs need to work together to find solutions......
    However, it is much much easier to sit back and moan whinge and rant...
    some of us don't want to leave to Australia and can't retire.... we are the ones who are fighting for the survival of the NHS and General Practice, for the benefit of our practices and our patients.....

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  • How happy are secondary care consultants in FT's?

    My point exactly.

    -anonymous salaried!

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  • @anonmous salaried 10.3.15 6:36pm

    I admire your courage and positive attitude. A lot of what you write is correct and interesting. I believe that a lot of doctors, myself included, use this forum for a moan because of the disempowerment that has occurred over the past few years. It used to be the case that when a scheme was being proposed it was discussed and negotiated with both managers and clinicians having a reasonable mutual respect for one another. However recently it's been one sided and generally imposed without thought or regard. The negativity in the forums here, I believe, is far less than that spewed out on a daily basis by the media despite our best efforts and endeavours. The reason GPs are leaving for other shores or retiring is because they feel they cannot change the direction of the profession- our leadership (BMA/ GPC and even the royal college) have let the profession down and stood idly by whilst the public have had to endure a degradation of their health service.

    Perhaps if everyone had your spirit we wouldn't be in this mess but the reality is that we are a very divided profession and have been greatly weakened because of it and our dear politicians are well aware of this and have taken advantage of it at every opportunity. Retiring or emigrating isn't waving the white flag, it's a two fingered salute to those that really don't give a damn.

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  • Once again a whole series of experiments approved that are not backed up by evidence and based on nebulous criteria will be launched in different parts of the country. I am in my 40s cannot retire and do not wish to emigrate but view these changes with great trepidation and a sense of relief that they are not happening in my area....yet. I am not against change but this pace of change is unrealistic and could be dangerous and detrimental to patients. We know what the problem is, an ageing population on the one hand and a younger population that has lost much of its respect for a doctors and other professions. Demand and expectation has been reset by politicians in such a way that no system however eficient can cope. I'm afraid my diagnosis is that the NHS is being set up to fail. As my previous colleague has said all these changes have been imposed on us without mutual respect. I cannot blame everyone else from abandoning ship.

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