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GP funding to be pooled with secondary care under radical CCG plans

GPs could see their enhanced service and QOF funding pooled with secondary and social care budgets under radical plans being discussed by a CCG

NHS Somerset CCG - which has already successfully signed up the majority of practices in the area to a local scheme to replace the QOF - has outlined plans for all health and social care providers to move towards a ‘capitated outcomes-based and incentivised’ form of commissioning.

The move to pool CCG budgets with Somerset County Council and NHS England would be the first to include general practice in a pooled budget based on shared outcomes.

Commissioning leaders were unable to elaborate further on which GP budgets would be included, but local GP leaders told Pulse that there have been discussions about moving elements of the GP contract into the shared outcomes scheme.

The move to introduce ‘outcomes-based commissioning’ (OBC) follows similar models set up across the country, inlcluding the move to local authority-led commissioning of health and social care services in Greater Manchester.

The CCG’s business model for the plans stated: ‘General practice will play an important role in the move to [outcomes-based commissioning], but there are significant challenges to the full inclusion of primary care because of the nature of their contracts with NHS England and current demand pressures on the workforce.’

Its business plan put forward a series of recommendations, including:

  • ‘Agree in principle to future discussions to pool budgets for health and social care, subject to these proposals being reviewed and agreed at a future meeting.’
  • ‘Approve in principle a move to a capitated outcomes based and incentivised commissioning approach for health and social care services in Somerset.’
  • ‘Agree that the CCG via the clinical operations group engages further with primary care providers and NHS England to develop detailed options for practices to participate in OBC.’

The CCG’s governing body members approved the plans ‘in principle’ at the latest July board meeting in an attempt to secure over £200m efficiency savings required by NHS England over the next five years.

Dr Harry Yoxall, medical secretary of Somerset LMC, told Pulse: ‘We’ve had very early conversations with the CCG and the area team about whether there are elements of the contract that could be included in outcomes based commissioning, but that would not put the core contract at risk.’

Dr Yoxall added that it would ‘make sense’ for GPs to be involved in an integrated, outcomes-based model, as ‘80% of NHS contacts take place in primary care, and GPs are able to intervene at an early stage’.

However, he said there was ‘no suggestion’ that the core GP contract would be affected.

Dr Yoxall said: ‘There is no suggestion at the moment that the core contract, the GMS or PMS, would be in any way involved with this – some of the peripheral contracting, some of the enhanced services for example, could reasonably be transferred into this new contracting model.’

A spokesperson for NHS Somerset CCG said: ‘The plan to introduce OBC contracts in Somerset from April 2017 does not include the creation of a single accountable care organisation across the county. It is based on two lots covering the east and west of the county and does not specify the form which providers might come together to work.’

‘Somerset CCG has not made a decision as to which elements of primary care funding will be included and is committed to further discussion with local practices before any decision is made.’ 

The CCG is seen as a trailblazer for new models of working and has caused ructions with the GPC over the past year after agreeing with the LMC and local area team that GP practices could ditch QOF work, replacing it with an alternative funding stream underpinned by broader outcomes measures shared across practices.

Readers' comments (13)

  • I would be very frightened that the pooled money disappears from general practice and ends up in secondary or social care organisations. There is a considerable level of risk that this scheme removes yet more money from already struggling practices.

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  • This will be the nail in the coffin for myself and most GPs in their late 50s. If you lose us GP will collapse.

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  • " ‘capitated outcomes-based and incentivised’ form of commissioning."

    management yuk-speak. That alone should ring alarm bells for general practice.

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  • yes more work for overstretched GPs
    complete non sense with a methodology never proven to work .
    the local GPs should think about vote of no confidence in their GB members

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  • That's the danger - all the money ends up propping up PFI or such like and GPs get nothing - or are just expected to do the work. We have a federation this is exactly sort of thing they'd want - but wouldnot help GPs. Capitated budgets for outcomes us menas her's some money treat their diabetes. If GPs not directly paid they will only get money to do it after whoever is prime provider makes a profit.

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  • this is the most dangerous thing for General practice.

    Core funding does not cover core work.

    Why no resistance from the GP's - are they stupid or are they being guaranteed funds from other sources.

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  • Payment per item of service. otherwise this is dead in the water causing more drain of GP's from the system.

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  • This essentially means, hand over Primary care budget to secondary care and just do what the hospital tells you to do. A bit of a glorified SHO role if you ask me. THat is what we are heading for. Not long before we start getting letters ---> Pt getting discharged tomorrow, GP to clean house and get heating, shopping sorted prior to arrival (and report back to Hospital Consultant), change pad tomorrow (and report back to Hospital Consultant), make breakfast as per patient's wishes (and report back to ....), do a home visit at 2200 to ensure doors/windows locked (and report back to someone at the hospital) etc etc etc.

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  • The bell tolls for General Practice. Practice with a patient centered practice will die.

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  • During 6 years of unprecedented growth in NHS funding, under PCT management ... organisations that ostensibly were supposed to develop primary care... general practice got a total of ZIP.

    The councils were given the Public Health budgets, which they have cut, and recommissioned poorly, often to themselves... wait till the smoking cessation results come out next month.

    I wouldnt trust my CCG managers anymore than the councils; would you ?

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