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GPs should be offered new voluntary contract 'based on outcomes'

GP practices should be offered a new voluntary contract based on outcomes that would ‘sit alongside’ existing contracts, recommends a leading thinktank.

A report from the Kings Fund - published today - urges the new contract to encourage GPs to form federations and integrate with other services.

Published today, ‘Commissioning and funding general practice: making the case for family care networks lays out a plan for providing patient services outside of hospitals, with general practice at its core.

They build on ideas published last July by the King’s Fund and the Nuffield Trust, but have been criticised by the GPC as ‘another reorganisation’ rather than addressing the ‘serious workload and funding challenges’ already faced by practices.

The report says that the coalition Government’s reforms since 2010 have ‘focused far too much on the involvement of GPs in commissioning’ rather than improving their role as providers.

To do this it proposes a voluntary contract to encourage practice to form alliances together to provide ‘more comprehensive care outside of hospital’.

It says: ‘Practices able and willing to do more would have the opportunity to take on a budget with which they would form federations to deliver care and integrate with other services.’

It adds: ‘Most GP practices are too small to do this on their own and need to work together in federations or networks to achieve the necessary scale.’

The federations would take on the new contract which would allocate funding based on the list size and need of the practices involved, and set outcome targets - allowing them flexibility in how they achieve them.

King’s Fund chief executive, Professor Chris Ham, said: ‘This new funding and commissioning model for primary care could offer GPs an important opportunity to lead the way in finding new and innovative ways of working.’

‘At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring funding into general practice if GPs take responsibility for providing and co-ordinating a wider range of services.’

But GPC Chair, Dr Chaand Nagpaul, said the King’s Fund report is right to recognise ‘the unique contribution’ general practice makes. But he added: ‘However, general practice does not need another reorganisation on the back of the incredibly time consuming and costly restructuring GPs have only just undergone.

‘Instead we should be focusing on tackling the serious workload and financial challenges facing GP practices, and supporting them to evolve and develop rather than wasting resources rearranging the NHS’ already complicated bureaucracy.’

NHS Alliance chair Dr Michael Dixon said they ‘fully support’ the report, and that it was important that general practice ‘took take the initiative’ on developing care in the community.

He added: ‘The real issue is how do we keep the small is beautiful aspect of GP – the relationships with the patients and personalised care – while also enabling it to work at scale to provide services outside hospital, and become a serious influencer of local health.’

Readers' comments (8)

  • What planet do the inhabitants of the Kings Fund live on? Sign up early to avoid disappointment.

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  • 'general practice does not need another reorganisation' - the trouble is primary care was last reorganised in 1948

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  • Outcomes have a large social and public health input and a small medical input. Its akin to paying the government ministers based on good weather conditions! Post code is a factor in QRISK2.

    Incidentally King`s fund is not in first in suggesting this line. In ancient Egypt physicians were paid on the weight of the beard grown by someone who was ill as they stopped shaving when they became ill. The idea being the longer the illness the more treatment the physician has to give. 5000 yr old idea- has come a full cycle.
    Does Kings Fund also recommend some for the post of "Caretakers of the Pharaoh's anus (yes that's right, and it was a high ranking position too!)"

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  • Vinci Ho

    So politically , this is big slap on the face of this government by King's Fund when it said too much focus was on GP commissioning and hence not enough productivity (Mmmmm , who is telling the truth ???)
    Like everything , GP federation idea must have its advantages as well as disadvantages especially depending where you are. Have these been sensibly debated before going ahead?
    The other thing is how can one guarantee that the ultimate budgets and level of funding to deliver services in a newly formed federation will not be 'shrunk' as part of the austerity measure? (Or you can argue it is part of the 'famous' Nicholson's challenge!)

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  • So last reorganisations not working or not capable
    of delivering change!
    So let's suggest new contracts until those are
    Found in affective then let's change or suggest more!

    May be just may be it's the constant change
    that's the problem and all it does is keep
    Useless academics and advisory think tanks
    in over paid employment

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  • To liberate general practice ,
    allowing it attract private investment
    for property improvement and allow practices
    to merge possibly along commuter lines
    We need practices to be able to be sold.
    Investors need to be able extract reward for
    their investment.
    Benefits
    Investors bring in expertise in driving efficiency
    Ie single call handling for multiple practices
    Better staff mix
    Sharing of skilled staff
    Driving up patient satisfaction to create a valued brand
    Having proper organised training in place for all
    Unified approach across regions ect
    I accept there are negatives such as loss of control
    to some extent but with proper safe guards such as
    Practices not being able to shrink practice areas..
    May be worth pondering ?

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  • Practices being able to sell themselves to large private sector players gives a windfall to the existing partners... not sure how well that will go down with the general public when all the value has been created by NHS funding

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  • Ref value added by NHS funding.... Is that the same for
    Pharmacies or any private provider of NHSServices.
    I think selling shares in the practice to attract
    Funding to invest to expand/ merge ect is a small price to pay to make a change from the current cottage system of practices to the modernisation required.
    Ie less reliant (or begging for monies to expand services / improve infrastructure )in tax payer funding but on those trying to increase value in their brand by improving services and attracting patients.

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