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Gold, incentives and meh

GPs set for funding boost as NHS England considers 'redirect' of £3.8bn integrated care funds

Exclusive NHS England are looking ‘very closely’ at how to inject more investment into general practice, including redirecting money from hospitals using a new fund earmarked for more integrated care, says a health minister.

Earl Howe told the Family Doctor Association conference in Nottingham last weekend that NHS managers were looking at how the £3.8bn integrated health and social care budget could be used to help boost investment into primary care.

The new budget – announced by the chancellor George Osborne in his Spending Review in June was to be used to jointly commission services across health and social care by 2015/16.

The DH said the pool will include: £1bn taken from the existing NHS budget; £800m that has already been announced for social care; and £2bn of new money being invested.

Pulse revealed last month that CCGs in the north west of England have applied for funds for GPs to offer routine appointments seven days a week, under radical plans to help ease pressure on A&E services.

Earl Howe said that they were looking at how ‘existing funding can be used up more effectively’ than it is at the moment.

He added: ‘This whole agenda implies the need for more investment in general practice, and I know that NHS England are looking very very closely at that.

‘It is their job as commissioners of general practice and primary care to ensure that proper capacity is there, and that means more bodies on the ground, more GPs, more nurses.’

But he warned that the shift of funds into general practice should not be ‘destabilising’ for the acute sector.

He said: ‘Acute care is very expensive. It’s not always the right thing for the patient. It can lead to a vicious spiral, particularly with elderly patients who leave hospital worse off than when they went in.

‘We have to redirect the money, and the integrated budgets will help in that context. They will involve a conscious effort by both health and social care commissioners to commission the right care for patients and focus on the preventative agenda.’

The health minister revealed that, ‘at a recent roundtable meeting the health secretary referred to the ‘three Cs’ as his vision - C for continuity of care - ensuring patients always know who their GP is and who is accountable for their care, C for control: that services should be tailored for patients with their GP and C for the contract - getting the contracting arrangements right to incentivise out of hospital care.’

Speaking about the move away from the traditional view of a community doctor, he told the conference that, ‘the secretary of state has often spoken about a return to family doctoring. It is essential to retain the best principles of having a family doctor which is: continuity of care.’

Addressing the concerns in the industry regarding increased workload with out-of-hours care responsibilities, he said, ‘ultimately, what we as ministers want is for GPs to feel responsible in the fullest sense for their patients. That doesn’t mean a return to delivering out-of-hours care but it does mean ensuring that care is provided so that patients can have access to the right care.’

Readers' comments (6)

  • Sounds sensible but it is how this investment is used to improve care in the community that is key. This almost certainly means a change in the way that General Practice functions - so we maintain continuity/cradle to grave care, yet systematically improve care of long terms conditions and urgent care.

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  • How does NHS ENGLAND taking £8million next year from our local area budget square with this announcement.

    How does taking money out of QOF help practices either.

    How does completing tenders for Public Health and soon to be Locally Enhanced Services help practices to bring care to their patients, too busy box ticking to concentrate fully on patient care.

    You can't do more with less resources, no matter how it is dressed up. Continuity of care is not helped when your budget is cut and you have to do more box ticking.

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  • ‘ultimately, what we as ministers want is for GPs to feel responsible in the fullest sense for their patients. That doesn’t mean a return to delivering out-of-hours care but it does mean ensuring that care is provided so that patients can have access to the right care.

    This is thir true intention, don't be fooled by the apparant "investment" (which I'm sure will be cost neutral at best, probably cost negative).

    We, the grassroot GPs are clinician, and providers, not commissioners. We are only labelled as commissioners in the government definition because we were forced into joining CCGs. Why are you asking us to be responsible for commissioning when it's clear individual GPs have no say in strategic planning such as OOH care?

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  • Unlikely to acheive much with such an ongoing haemorrhage in GPs abroad and into early retirement - you need a workforce to do MORE work. With an effective tax rate of over 80% for those earning over £100,000, there is certainly no incentive for the remaining diminshed work force to run faster on their treadmill!!

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  • It will be interesting to see what metrics are used to show that this results in better patient outcomes for all and not just better profits for practices. Of course extra work should give the practice extra income, but it needs to be comensurate with the improvement in outcomes.

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  • @Anon 1.49 - I think that is a very good point, but one which is difficult to square as we all know that the money will come with strings attached. Often these strings are what politicians and patients want, rather than improving health outcomes.

    Almost certainly it will be linked to access, which has never been demonstrated to improve clinical outcomes or reduce attendances to A+E/ admissions to hospital.

    The original QOF, where the targets were based on evidence (like ACE inhibitors for those who have had an MI) would improve outcomes, but the DofH will not let clinical outcomes get in the way of winning votes with health checks/ weekends/ special schemes/ etc.

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