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'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)

  • 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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  • David Bush

    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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