Exclusive GPs could be bought-out of their premises and have their staff redundancy costs covered in one of the most radical plans to encourage practices to merge yet.
NHS Hull CCG is aiming to bring its 55 practices together into eight ‘practice groupings’ throughout 2016, and has identified a range of support measures to enable this, including ‘exit packages for staff’, paying legal fees and funding new clinical schemes.
In return, the practices will provide seven-day working and will work in multidisciplinary teams.
It follows on from similar plans in the South West, where practices are being given funding worth up to £40,000 each to help them merge, while commissioners across the country are trying to incentivise working at scale in line with NHS England’s plans.
However, the plans in Hull go the furthest yet. The model, set out in the CCG’s primary care ‘blueprint’, was created in response to the significant undersupply of GPs in the city, which is 50 whole-time equivalent GPs short compared with the national average of 60 GPs per 100,000 people.
The CCG has implemented several schemes to increase recruitment in the city, such as a failed ‘golden handshake’ scheme, and even considered a move to a fully salaried GP service.
But the latest strategy is pushing towards changing the make-up of the practices in the city, in part by using the Government’s ’transformation fund’, which was originally intended to improve GP premises (see box).
The blueprint states that the first step towards sustainability for practices is to improve premises and retain current GPs as part of their move towards larger practices.
In order to do this, practices will be given support including: ‘Exit packages for staff, including GPs; estate solutions eg. buy-out of estate once alternatives are confirmed and secured; new clinical schemes with financial support to deliver services; IT alignment; set-up costs; legal fees.’
An NHS Hull CCG spokesperson told Pulse the funding would be drawn ‘from the CCG’s allocation, NHS England Primary Care funds and the Primary Care Transformation Fund’.
They added: ‘We have modelled the future landscape of primary care based on eight practice groupings, however it will be for individual practices, as independent contractors, to confirm the final configuration.
‘There is not a deadline [for practices to form groupings], however the CCG and NHS England will be working with practices and practice groupings throughout 2016 to support the development of the new models of primary care.
GP leaders say they expect changes to proceed slowly.
The chair of Humberside LMCs, Dr Russell Walshaw, told Pulse: ‘I think the management of the CCG would like to push on, but they recognise – because we keep telling them – it’s a membership organisation. The members decide how it goes, not the managers who they’ve appointed.
’People are changing their views [on merged working], as they start to see the benefits. But it’s a very slow process and if NHS England and the CCG is going to put money in it, that’s fine, it will need money. But it’s in very embryonic stages at the moment.’
Pulse revealed a similar plan to incentivise practices towards mergers and working at scale across the South West, with a £1.07million fund being set up by NHS England’s South West area team. The leaked plans seen showed that £40,000 was being invested in one merger of 13 practices, and ‘programme management’ to address innovative new services and offering unified care across the group.
What is the ‘transformation fund’ about?
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The £1bn Infrastructure Fund was launched in 2014 by chancellor George Osborne to fund a national upgrade of GP premises. Practices had been asked to submit bids for a share of the first tranche of money – £250m – in January last year and more than 1,000 were given approval in March.
But Pulse revealed that area teams were reneging on funding they had pledged last year, claiming that practices were not ready to proceed with premises upgrade.
Shortly after, NHS England announced that the scheme had been overhauled, and practices would now be required to submit proposals that were aligned to their own CCG’s objectives.
The bids for the next tranches of money would be judged on certain criteria, including:
- Increased capacity for primary care services out of hospital;
- Commitment to a wider range of services as set out in commissioning intentions to reduce unplanned admissions to hospital;
- Improving seven-day access to effective care;
- Increased training capacity.
But the GPC has warned that the overhaul of the scheme would see funding meant for GP premises ‘siphoned’ off into other projects.
