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GPs go forth

'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.’

Related images

  • Simon Stevens - online

Readers' comments (35)

  • "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


    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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