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GPs buried under trusts' workload dump

'Corner shop' GPs should expand and employ hospital consultants, says NHS England

GPs will form ‘expanded group practices’ which employ - or take on as partners - hospital consultants, pharmacists and social care workers, under a radical plan to be announced by the chief executive of the NHS today.

Simon Stevens will announce an NHS England plans to completely break down the barriers between primary and secondary care over the next five years, with GP practices encouraged to employ a wide range of staff from secondary, community and social care, and hospitals given the freedom to set up GP practices themselves.

He will say at the annual RCGP conference being held in Liverpool later today that new ‘care models’ that break down the barriers between primary, secondary and community services must be introduced to facilitate more ‘joined up’ care.

Mr Stevens will say that the ‘corner shop model’ of primary care is ‘past its use-by date’ and that GPs must be open to operating larger practices and breaking down the current model where patients fall through the cracks between services.

He will also say that hospitals in particularly hard-pressed areas will be able for the first time to start their own GP surgeries with registered lists - thereby ‘unlocking’ investment to improve primary care premises.

The radical plans are contained in the forthcoming ‘NHS Five Year Forward View’ from NHS England, and are the first major indication of how managers are planning to restructure primary care, since its chair announced a ‘fundamental review’ of GP contracts in 2013.

Mr Stevens will say: ‘The national debate on the NHS is now picking up steam, and GP services are rightly at the centre of it. But alongside more doctors and more funding, we also need new and better ways of caring for patients, especially older people at home.

‘GPs themselves say that in many parts of the country the corner shop model of primary care is past its use-by date. So we need to tear-up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists, and where patients with chronic health conditions are increasingly passed from pillar to post between different bits of the health and social services.’

He will say that GPs could also even take on local community hospitals to use as ‘hubs’ to deliver more services like scans, outpatient chemotherapy and dialysis, locally.

NHS England said these models are expected do a better job of looking after people at home and preventing emergency hospital admissions.

The announcement follows earlier proposals from NHS England’s national lead on long-term conditions, former GP Dr Martin McShane, to set up GP practices employing both GPs and specialists that are dedicated to looking after more complex patients.

Mr Stevens will also announce a £5 million funding boost for GPs to increase identification of people with dementia - with practices being paid according to the extra patients diagnosed.

NHS England said as part of the investment, practices ‘will now be asked to work with a CCG on a clear plan to identify more patients’ and ‘work closely with nursing and care homes as well as ensuring that all patients diagnosed in a hospital have their records clearly flagged… [which] will help CCGs ensure there is the right capacity in clinics and where there are delays, GPs can raise it with the CCG’.

It added: ‘Practices will be resourced on the basis of the extra patients diagnosed to reflect this workload.’

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  • Simon Stevens - online

Readers' comments (35)

  • It is not the "corner shop" model that is at fault. The "corner shops" are not appropriately funded for the care that they are now expected to provide. Communication from secondary care to primary care is generally late and often doesn't provide the information that is required. The ability to get patients seen quickly by secondary apart from in an emergency situation is limited. Waiting lists for secondary care services are too long. Out-patient appointments get re-scheduled over and over or at worse cancelled for no good reason. Not uncommonly patients admitted as emergencies do not get sorted out sufficiently and are dumped back into primary care unwell, resulting in re-admissions. Services for chronic conditions are being cut. Our dementia teams and social service support can't cope with the current patients they have on their books, let alone increasing the workload by finding more cases. I fully agree with better integration of services but that could be achieved with the present model if the issues raised above and others were sorted out.

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  • PS. It isn't all one way too. No doubt there are things that we GPs do or don't do that doesn't help the current system. And then there is the "small" problem of IT systems that don't communicate with each other...despite the billions that have been spent over recent years.

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  • Yes, being a GP Partner is so easy that hospital consultants could do it in the time they have left over from the hospital and private work that they do.

    Bonkers.

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  • Larger practices could have specialists working in them in and providing more specialist care to "triaged patients". Groups of smaller practices working together could do the same. We need a new structure to do this as we should look to have consultants as partners in our practices. Allowing Partnerships to convert to LLP would mitigate some of the current risks of being a partner and enable such inclusion of consultants as partners rather than employees.

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  • You mean the consultants would not want to be a partner with unlimited liability ?

    How wise !

    Pity our leaders could not devise a way of stopping us GP partners going bankrupt.

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  • Let common sense prevail

    Although Simon Stevens vision for integrated care has merit, does anyone else feel that his use of the term 'corner shop' gives away just what level of respect the government has for general practice?

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  • David Bush, I agree with you entirely and as a hospital trainee turned gp trainee - for variety rather than any academic failing or "weakness" - I totally regret my decision and I'm desperate to be taken back into the secondary care fold. I didn't train to be a doctor to be treated like crap and to be abused by a malicious govt which had stoked up public demand to a white hot level.

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  • So for this pet project valuable monies will be diverted to ensure some short term success but those projects will slowly die.

    How stupid are these people? At least in the genuine commercial world these experiments would be costed.

    You need real increases in funding to primary care - the system works. Where things need to improve focus and small funding improvements will probably deal with it.

    This is again based around deprived areas and inner city hospitals where the hospital could provide primary care from its existing infrastructure. Has nothing to do with the vast majority of primary care or non london hospitals

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  • As GPs, we are constantly being lectured to...receiving "wisdom" from NHS managers, the media and politicians.
    All these groups seem to have an astonisting insight into "what is best" for GPs despite never actually having any experience of General Practice or the issues involved. It is rather like being a theoretical "jumbo" pilot having never actually flown.
    Most of these "conversations" are unidirectional rather than meaningful dialogue.
    Until proper dialogue takes place and GPs voices are heard, respected and integrated into a shared vision, the "mess" that is General Practice will sadly continue.

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  • There is only one option for long term sustainable primary care, that is to move to a European insurance based system and ensure that work done commands an appropriate level of remuneration. Anything else is ultimately doomed to failure.

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  • "Father, forgive them, for they do not know what they are doing." And they divided up his clothes by casting lots.
    Luke 23:34

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  • of course the cynic would say that HMG wants GP to ask for co payment systems so the blame can follow GP's.

    You should be wary of this, because although most people would design an Australian type system you would end up with so many exemptions it would be worse then your current system

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  • I often wonder what went wrong.
    Before these guys took over, about 4 years ago- things were not perfect but we were working and patients were content. What stirred these nincompoops to destroy the system ?
    And now, indeed, we are talking shop !

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  • Bob Hodges

    Cornershop??

    Someone needs to tell NHSE that we're boutiques and delicatessens not cornershops.

    Do you think that they have meetings to deliberately come up with the most patronising and offensive languange to use about General Practice?

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  • I don't think Mr Stevens is the first to use corner shop as an analogy - did not RCGP too? - This model is looking for ways in which General Practice can be developed and this will include pressurising CCGs to extract from secondary care the tariff prices which can follow the activity away from secondary to primary care - primary care will become a matrix of boutique undertakings but it requires GPs to put pressure on the CCGs (themselves) and to challenge the NHS to fund the consequences of this long term, integrated care, GP led service - very few people seem to be taking this approach: why is that?

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  • I think you're exactly right Bob. I can only assume that there is a standing agenda item concerning the degradation of General Practice!

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  • We employed Consultants to work in the Surgery during fundholding. They wanted twice GP pay and have an entourage of nurse, secretary and receptionist at their beck and call. We barely had enough referrals from our 17000 patients to have a monthly dermatology clinic!
    A properly funded and resourced general practice is the best value for the NHS. Why keep returning to models that do not work!!

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  • Bob Hodges

    Let's reinvent the square wheel every 15 years!!

    It wasn't quite crap enough first time round, but with a bit of help from managment consultants we can make it utterly rubbish.

    When you ernestly believe that you can make up for a lack of talent by redoubling your efforts, then there's no limit to what you can't achieve.

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  • "There will be no top-down reorganisation during the term of this government". We remember what you said Mr Cameron, we remember. Now you're asking for our support and our votes again? The only sense in which you haven't re-organised the NHS is that you could call it a top-down destruction.

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  • 'although most people would design an Australian type system you would end up with so many exemptions it would be worse then your current system'

    This is false. All the Europeans use a similar co-payment model and they have just as many socio-economic problems as us but they get better outcomes for their people.

    If the NHS was a clinical trial, the ethics committee would have stopped it half way through because its outcomes are so much worse than the alternatives.

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  • GPs will be called Corner Shops as long as GPs function as one.
    Assess all patients properly & fully and manage locally referring only the right patients to secondary & tertiary services.
    You will save the NHS a lot of money and patients a lot of distress.

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  • If I was a running a corner shop with a queue at 8am and having to turn customers away I'd probably be underpricing and could afford to raise prices. Or I'd be stupid enough to build bigger stores with impersonal service and branch out and provide things outside of core value and end up with fraudulant money grabbing boards that over inflate profits and feed greedy shareholders their dividends on the back of sh*t service with everyone using them bemoaning the loss of their local store. Oh!

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  • Anonymous | Private GP | 03 October 2014 12:33pm

    Explain how this is to be done. NHS GPs receive the same amount per annum for each patient as some private GPs earn per patient contact. I would love to be paid for the actual units of work I do and to be able to spend longer with each patient and have some control over my workload. However sometimes when I'm seeing 25 patients in a surgery where I have 5-10 minutes per patient the 'quality' suffers. We are only human.

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  • Mr Stevens is giving the impression that the model can work in either direction, one of those directions being that GPs employ consultants etc, but his deputy medical director Dr Mike Bewick has already let the cat out of the bag, that NHS England will move the system in only one direction - that general practice is dead and primary care will be provided by the hospitals
    http://www.pulsetoday.co.uk/news/commissioning-news/gp-partnerships-will-be-gone-in-ten-years-says-nhs-england-official/20007868.article

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  • i'm confused ...

    1. in order to preserve local services and patient choice he wants to end local ('corner shop') practices and merge practices into larger (less choice) entities.

    2. in order to provide primary care services he wants large groups of practices to hire consultants and other 'secondary care' staff ... to me that's called a hospital???

    3. and in other reports they want us to bolt on to a&e departments. I wish they would be honest and say they don't want primary care or GPs and done with it.

    any youngsters reading this don't to general practice! as it's obvious from the 'leadership' GPs days are numbered.

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  • "This is false. All the Europeans use a similar co-payment model and they have just as many socio-economic problems as us but they get better outcomes for their people. "

    Actually that is not true, across a few areas of cancer care that has been reported. However dig a bit deeper and you realize that France for example have much poorer quality systems of data collection. there are whole sections (usually inner city french neighborhoods) where patients do not figure in the data.

    Can;t comment about other European states but I'm a little suspicious about some of the data sets they publish. That's not to say the UK is perfect but its up there and across the breadth of patient data and audit data it probably is the most reliable.

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  • Yes, customers(patients) should move back to using corner shops(GPs) rather than supermarkets(hospitals) so that more money income/outgoing occurs in the community

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  • This is nothing new.
    We hired consultants during the fund holding days.
    We had all sorts of contracts with the hospitals for diagnostics, physiotherapy, employing osteopaths and acupuncturists.
    Old wine in the new bottle.
    Navin Thakrar

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  • I don't understand why having a GP clininc in a hospital would be any better. We all know outpatients costs more that GP so surely it will just cost more and be more inconvenient for patients at the very best.
    Moving consultants in to community may be cheaper so perhaps worthwhile?
    To integrate better we need to have prompt and good communication and share the same computer system not be in the same building otherwise there would be no community care and that's the basis of good value patient centred care.
    Why cant these lot just shut up and either increase funding or not, educate the public on self care for minor illness or not. We don't want any other ideas if theyre all going to involve massive reorganization and wasting large sums of money.

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  • Tariff will not follow these new in-house Consultant Services: a proportion will be payable, but it's about saving money. Having Consultants in house would however be great for healing the "divide and conquer" NHS market and an excellent educational opportunity.

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  • tariff: part of the tariff covers the indirect/contribution costs of the secondary care system often the high PFI debt charges - the privatisation which quite a lot of contributors to these pages seem to ignore

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  • Why don't NHSE staff train up as medical 'assistants' - it is only 3 months and we can do with the help. They can deal with the paperwork that they created.

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  • More gas bagging impractical rehashed unfunded unpiloted idiotic wasteful schemery to give the impression of change so Simon can cause more damaging chaos .
    He really has shown himself as a national treasure in his hapless 'leadership ' so far.
    Simple Simon we have seen this all before and such schemes were a criminal waste of nhs money .

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  • Ps
    Same simple Simon who was health adviser in past with large role in the wasteful catastrophe of the internal market and trusts that led to Stafford and increasing nhs admin costs from 5 to 15% of nhs spend.this messiah returns from the disastrous disgraceful USA system returning as a one man weapon of nhs mass destruction.
    I cannot trust a single word from this failure.

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  • Does anyone remember when the profession wasn't micromanaged. It really is within some oldser GPs careers. The 'corner shop' practices were able to contact the 'hub'- we used to call it secondary care- discuss patients with appropriate specialists and get timely intervention.
    Now let me see !!!
    After all the 'improvements and managers sticking their uninformed beaks into the working practices of the professionals , Simon wants primary care to effectively employ consultants to do the same as occurred many years ago. His vision is staggering .LOL

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