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Struggling GP partners set to go salaried as trusts seize practice contracts

Exclusive Around a dozen further GP practices struggling with recruitment woes and defunding are in talks to give up their contracts and become employed by trusts, Pulse can reveal.

NHS England’s Somerset pilot for new hospital-led GP models could soon hold as many as 10 GP practice contracts, and employ all of the partners who are not retiring.

This includes three practices – with a combined 14,000 patients – that gave up their contracts earlier this month (8 April) as well as a further ‘six or seven’ that are in talks.

Meanwhile, in Yorkshire, a foundation trust has taken over a GP practice in response to a workforce crisis and the local PMS review, which saw the practice’s year-on-year funding cut.

It comes as a whole town of GPs in Hampshire are in talks to give up their contracts to the local Multispecialty Community Provider (MCP) vanguard, as previously revealed by Pulse.

Dr Berge Balian, GP lead for the ‘Symphony’ Primary and Acute Care Systems (PACS) vanguard in south Somerset, said the partners owning the 10 GP practices were opting to give up their contracts for a variety of reasons, but that difficulties recruiting and keeping practices financially viable were key driving factors.

The vanguard project, which includes the Yeovil District Hospital NHS Foundation Trust at the centre, has set up a holding company called Symphony Healthcare Services (SHS), which is owned by another group of ‘nominee GPs’ already working for the project. Through this, the PACS can continue running the GP practices under their existing GMS and PMS contracts, Dr Balian said.

He said the first three practices – Ilchester, Yeovil Health Centre and Buttercross surgeries – represented one case of the partners retiring and handing on their contract while the other two were run by a GP-held company that wanted to ‘offload’ the surgeries because they were ‘finding it a struggle to get a stable workforce in those practices and felt it wasn’t worth their while to continue’.

For the remaining six to seven practices where the partners are in talks to become employed by the trust, Dr Balian said it was a ‘strategic’ decision.

He said: ’I think for the second wave of practices, it is because they feel that the direction of travel of general practice is away from small partnerships.

’They think that, strategically, with the whole politics of what has happened in the last few years – with reduced funding to primary care, more emphasis on all the additional services that people need to provide and all the regulation that has come in – it has become increasingly difficult to operate even in a five- or six-partner practice.

’They see this model as being potentially the future.’

But he said the parties are in talks to keep a ‘reversibility clause’ that ’would allow those GPs to take back their GMS or PMS contract under specific circumstances in the future, [such as] if SHS were to fail or to be liquidated, or potentially if there is a proposal to sell it to a private organisation’.

At the same time, in East Yorkshire, the Market Weighton Group practice, a sizeable village practice with a list of 9,500 patients, was taken over by the NHS Humber Foundation Trust on 1 April.

A trust spokeswoman told Pulse that the Market Weighton practice partners had approached the trust directly about taking over their PMS contract. The practice said that the move would allow for ‘resources to be utilised effectively… and create a sustainable working model for staff and patients’.

As part of the transfer, three partners at the practice have become salaried to the trust. Although not yet a PACS, the parties said the takeover would lead to better integration between primary and secondary care services in line with NHS England recommendations.

It comes as in March, a mental health trust and a GP provider company in Sheffield agreed to jointly run five GP practices as the result of winning an APMS contract bid.

Primary Care Sheffield bid jointly with the Sheffield Health and Social Care NHS Foundation Trust, winning two contracts that cover 21,500 patients in the city.

What are PACS?

Like the new GP-led Multispecialty Community Provider (MCP) models, Primary and Acute Care Systems (PACS) aim to integrate general practice with secondary care services, but the difference is that PACS are run by acute trusts.

First described in the NHS Five Year Forward View back in 2014, NHS England indicated PACS would only be allowed in certain circumstances, such as in areas where general practice is ‘under strain’ – but arguably that now covers general practice in most parts of the country.

Already a month after NHS England’s high-level planning document was unveiled, management consultants were circling, with PwC reporting an ‘extraordinary level of interest’ among trusts running GP practices.

But GP leaders warned that a landgrab by hospital trusts would hold risks for GPs as it would allow trusts to ‘take over the world’.


Readers' comments (18)

  • @1210:Its a "no-brainer".Trusts already have the HR and Finance structures which makes it cheap and easy for them to absorb Practices, and gain a guaranteed income.
    I cannot blame Practices in distress for seeking this lifebelt, but in terms of transforming Primary Care from what it is to what it could be, it represents a cul-de-sac.
    Hospital Trusts know little about General Practice and care less.
    Unless GP Federations can seize the day, articulate their vision and lobby for funding, General Practice as we know it is doomed, and will implode quicker than anyone might think.

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  • @9.42 practice manager.

    There is no need for procurement law. GP partners are free to arrange succession to whoever they want. The article suggests named GPs have set up a structure in which they do this without fully giving back the contract.

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  • I think there is potentially an argument for a salaried service (Sick pay, holiday pay, funded study leave, indemnity, crown cars(?)) but it sounds like theses practices are being forced into a corner.
    Good luck!!

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  • JH's master plan is all in motion and working like a charm.

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  • Jeremy (Corbyn) if by any chance you read this then I suggest your party starts a very active opposition to Tory destruction of the NHS now.

    Start telling the public how much more USA style "Huntcare" will cost them and how much profit health insurers hope to make out of the market.

    While loosely cloaked in science, the values underpinning Tory plans are rooted in greed and privatisation.

    If you fail fight their plans and stand quietly by while the NHS is destroyed, your party will never be electable.

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  • Trusts get 25% more per patient [ admin costs ].Simple

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  • Speaking as one who was formerly employed by one of these practices, it wasn't struggling rather patient population was growing. But management 'mismanaged' their staff, poor terms and conditions, changes to work hours, restrictions on training, new practice managers, imposed new contract and reduced pay to increase profits for the partners/director. Oddly enough when that happens good staff tend to walk away - hence the staffing problems mentioned. Whilst we all know that GP practices are businesses, the moral is if you are in a position of responsibility as a partner/director - lead your team responsibly - Operor unto alius ut vos would have lemma.

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  • Don't assume private companies will come to cash starved units without potential guarantees. It is messy and needs a new management and culture. If patients don't pay there will be the risk NHS just changes contracts like PMS practices know.
    Trusts are stupid to add surgeries when they have no profits .

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