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Whole town looking at employed model of general practice

Exclusive A town in the south of England could see its entire general practice population give up their independent contractor status and move to an employed model, Pulse has learnt.

GPs in Gosport, south Hampshire have approached the ‘new model of care’ provider in the region to give a presentation on how a salaried model could work for them, the GP lead has told Pulse.

Such a move could see a ‘significant reduction’ in the number of traditional practices in the area, he added.

GP leaders have warned that the new models of care could lead to practices being ‘devoured’ by hospitals.

The new models of care promoted by NHS England provide both primary and secondary care services.

The Better Local Care (South Hampshire) Multispecialty Community Provider (MCP) vanguard is being led by the local foundation trust.

Pulse has already reported two Gosport GP practices sought takeovers by Southern Health NHS Foundation Trust, after the workforce crisis left partners facing ‘physical and emotional collapse’.

But the GP lead of the South Hampshire MCP vanguardhas told Pulse the other nine practices in Gosport have asked for a presentation on how the new model could work for them.

Dr Donal Collins told Pulse that the model they were considering would deviate from traditional salaried model by setting a minimum earnings threshold and keep GPs invested in the practice, instead of punching in and out.

However, he also noted the move could see a significant reduction in the number of traditional GP practices in the area.

He said: ‘All the practices in Gosport have indicated they want us to present a detailed plan of the employed model for the whole area, what it would mean for them, and what it would mean for patients.’

This would be partly done through the MCP, which includes 30 GP practices, Southern Health and community providers.

And Dr Collins added the new model was already making a dent on workforce issues, with two newly qualified GPs from neighbouring Portsmouth approaching one of the Gosport practices asking to work In the vanguard.

He said: ‘Because it’s a bigger wider system, the younger guys coming in are finding it attractive… So for them it was part of being an employed salaried model, but not having the risks of taking on property ownership or leases. Property is a bit of a toxic thing.’

Dr Nigel Watson, chief executive of Wessex LMCs has confirmed that Gosport general practice is under immense pressure, but said ’about half the practices are exploring this option’.

What are the new models of care?

Simon Stevens - online

Simon Stevens - online

Nine hospitals and 14 GP-led bids were been given part of the £200m funding to provide integrated primary, secondary and social care, which will allow them to appoint GPs, as part of the the implementation of NHS chief executive Simon Stevens’ Five-Year Forward View.

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.

Read more here

 

 

Readers' comments (30)

  • Primary care hospitals vs Secondary care hospitals. Interesting.

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  • As long as the patients get good care it does not matter whether its is MCP or PACS.
    Unfortunately many Trusts have been declaring themselves to be in deficit but have set aside huge amounts for "restructuring plans" to buy off CCG`s in deficit and forming ACO.
    Obviously this is not a level field for GP`s to compete with.
    Please see HSJ article on same
    "Department of Health has sent accountancy firms into NHS organisations" - 20 Trusts and CCG`s to ensure their accounting is correct!
    The corollary is that DOH is asking Trusts to fudge their accounts so as to appear to be in better financial position than they are!
    "may you live in interesting times" -was never more appropriate for medical politics.
    Can the editor get the list of 20 CCG`s and Trusts which are being re audited by DOH?

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  • I would be most interested to see what salaries and t&c's are on offer. can't be good for the current partners who are used to being bosses and not dictated to by clip holding noctors.

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  • Bob Hodges

    Good luck to them, but the thought of having to do this myself makes my mind wander towards Australia, Canada, Ireland the Falkland Islands. Anywhere but here.

    'Salaried' and 'Gosport' in the same sentence is a unique overlapping of two distinct circles of hell.

    DOI: From Chichester.

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  • Vinci Ho

    A Chinese saying,' the situation and circumstances are lot stronger than man'
    Inevitable
    Predictable
    Circumstantial
    No rights or wrongs
    Question remains , what are the terms and conditions of each employee?

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  • Vinci Ho

    But then again,
    The same saying applies to all including politicians and circumstances are everchanging with time and history ......,,,,

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  • To all deluded partners out there,

    Doctors should stick to what they do best and let the managers do the rest.

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  • @11am

    Our practice is run extremely well, by us.
    Not every partnership is collapsing.

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  • Has anyone deigned to ask what their patients want? The cradle to grave responsibility will be gone with patients losing their registered doctor and UK general practice as we know it will sink rapidly into the mess of ACO's in America. For those who follow Gavin Preston M.D. he has been warning of this folly for years! There needs to be an acceptance by those in charge of the NHS and those that pay for it that there is no business model that works for the socialist ideology that is the NHS. We need to accept how much it costs and find a way to pay for it.

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  • A couple of issues:
    - No one seems to be able to answer the question of whether an FT running a PACS can also charge patients privately in the way that it can for 49% of its normal capacity. If so, PACS is clearly better than MCP as it means you can earn more to pay for all the resources you need to exist.
    - Competition and Merger Authority will probably need consulting on this as it could result in a monopoly provision in an area. Expect this one to come up a lot more as we progress down the ACO/MCP route.

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  • Can we actually offer "cradle to grave responsibility" in any meaningful sense anymore?
    How many GPs now do 10 session weeks?
    How many do their own OOH?
    How many do not take holidays?
    Also correct that there is "no business model that works for socialist ideology", so the inference should be that we ditch the fixation with ideology and learn from models in place elsewhere in Europe.

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  • Socialism has an expiry date and ours has just arrived.

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  • Joe Mcgilligan is spot on. What do patients want and do GPs really want to give up resposibility for, and the many different rewards of, cradle to grave care of their patients. As a patient, I am appalled and, as a recently retired GP, I am very sad. It is long past time for a proper discussion about the merits and needs of general practice with patients, the public and managers. Perhaps it could still happen if there is sufficient will...?

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  • @ 11:13

    'Our practice is run extremely well, by us.
    Not every partnership is collapsing.'

    Says....you! And you are very objective cause you have NO conflicts of interest right?

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  • The evidence is strongly against non partner run practices being cheaper or better quality when they compete on an equal playing field ie same £/head.
    'Professional' corporates are handing back their contracts as quick as partners now the £200/patient rates have fallen. PCT/manager run practices often had recruitment, quality and retention problems.
    Pulse reported in recent weeks that Welsh health board run practices receive £29/head more to pay for staff.
    So no, leaving management solely to 'managers' is not the answer.

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  • The basic concept is flawed because funding is so different. Trusts get better funding per patient. GP land may be OK for some, but its principle is flawed in so much as funding per patient and not activity has seen consultations double with a cut in profit of 50%.
    The principle of General Practice s no longer valid or fair or equitable and it must and will fail because the % investment has fallen from 11% to 7.5% and the % consults have risen from 60 to 90%, all because it is paid per head.
    So the DOH will dump and dump and dump.
    Wouldn't you if you were a manager and found mugs to do more and more work for less and
    less.
    Of course, some GPs are OK = their finding per head may be 220. The one going down only get 100.

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  • Vinci Ho

    Interesting argument about the difference between PACS and MCP in terms of being able to charge patient for private consultation. Everything is only down to political 'interpretations' anyway.
    In fact , this may be the catch whether things can work or not . And as I always say , weekend routine GP appointments should be charged with a fee.

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  • I think GPs should look at leaving ICS but not relinquish their Independence to FTs .

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  • @ Dr Gerada,

    Freelance snipers, yeah! ( I kida mean it )

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  • You simply can't let patients get in the way of the smooth running of the health service! The system must balance and patients just add cost and uncertainty! Everyone must watch 'The Compassionate Society' episode of Yes Minister to understand what I am getting at!!

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  • Took Early Retirement

    Gosport- gateway to Fareham. Luton-on-sea.

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  • It would be interesting to know what conditions have been offered to Practices both salary/perks and for premises owners.
    The devil is in the detail but we need to keep options open i.e. if we have any !

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  • www.veoh.com/watch/v21038684cmxmQW3Q for those who want a laugh and cry!

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  • Way to go

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  • I have it on very good local authority that not all partnerships are on the brink and are not best pleased with this announcement on their behalf with little consultation . Conspiracists saying this is a Southern Health takeover of primary care .

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  • A bottom up opinion...well almost...

    YES, there are some extremely well run and conscientious independent GPs / managers running their practices BUT in my observation and experience working "under" them since 1999 they OFTEN, frequently (but not all)...

    *Work in a kind of "closed shop" environment, often self-back patting on what they think they do well.

    *Work in the delusion that they are somehow "a business" when their funds come as a lump from Government and their "customers" are as tied in as they are to energy companies. Free to leave but often don't.

    *Many GPs are business (money) focussed rather than patient and staff care at heart. Too often I see a poor GP with two homes, holidays twice a year abroad, a huge non-environmentally friendly car (based on status), whilst they "cannot afford" to buy equipment that works, is maintained, give proper pay scales for grade of work, even lunch breaks for full time staff!

    * GP's often perceive they are super intelligent because they got into Med School, yet often miss simple things. GP intelligence can be great in tunnel vision understanding the depth of a subject down to atomic level, yet so often miss the bigger picture and lateral thinking.

    I could go on with various examples and I am not sure a central management to GP land would be better either. It depends on so much.

    YES, GPs do deserve more pay than the rest of us. I don't deny the responsibility and the commitment, but right now and since the mistake of 2004 QOF, it is ballooned out of reason and the differentials are unacceptable.

    We need a management that understands ALL roles and what they can offer safely. Use peoples skills and allow some transition with experience and further training.

    For years we have seen, up to appraisal and revalidation, GP's who did as little as possible to learn beyond their qualification. whilst some nurses (not all) have worked their butts off for 20-30 years doing modules in this and that.

    I thought I was stupid getting zero GCEs, but I still came middle when I did an exam with mainly GPs at Warwick Medical School. That means 50% GP's scored less than me, yet working in Primary Care means many nurses careers are strangled by GP's who have little knowledge about the team who they employ and the potential to improve patient care and staff motivation.

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  • 3.12pm clearly very embittered suggest she/he either moves to find a practice that treats her/him better there is a huge shortage of practice nurses after all . Alternatively suggest she/he compares pay differential in uk to other developed economies sorry but doctors do deserve to be paid more than nurses for the responsibility they carry and that is the case across the world but if the docs she /he works with are not providing a good service then maybe she/he should whistleblow and not tar all GPs with the same brush

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  • Anonymous | GP Partner31 Mar 2016 5:35pm

    Sorry if I come over as bitter, but no, just frustrated.I didn't explain that my experience comes from working in 8 different practices but have been where I am for 12 years. You may see I have samples quite a bit of independent GP employment. However, this is not just my experience but that of many practice nurses. Probably as high as 50/50 so there are some great employers too, but not enough, and not enough sorting out the bad ones hence why salaried for all could be a good thing.

    I did acknowledge that GPs should have more pay than other members of the team and never disagreed with that, but not triple the pay.

    I have whistleblowed but it's all very subtle and accumulative and very isolating. Now I am near retirement I am happy to keep up the pace of learning and more modules and hoops, but sometimes the devil you know....

    Just wish some GPs would stop tarring all nurses with the same brush. Some of us are covering up lots of things you miss and saving butts.

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  • The BMA contract and salaried status is the way to go
    The extra costs are then some one else's worry and we can advocate for good medical care and longer clinical time with patients
    Would be a win for patients and doctors especially extremely stressed partners who shoulder financial risk and management stress
    May be we can all be locums and work by the hour?

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  • I cannot ever understand how a system that is so utterly discriminatory exists for so long.
    It is completely absurd that one GP gets 110 and another 220 pounds for the same work.
    There are some differentials in morbidity and rentals and so on, but the difference in funding is so great as to be abhorrent.
    To add insult to injury, the guys getting 220 are wondering what the 110s are complaining about, the whingers, I am allright Jack.
    How can it be right that health boards get 30% more per patient.?
    We should all resign, really.
    But this is fair Britain, apparently.

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