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Alternative GP contract needed so practices can expand, say think tanks

GPs should be offered a completely new alternative contract to encourage them to ‘transform’ into larger units that provide a much wider range of community services and take responsibility for the social care of their patients, according to a radical report being considered by NHS chiefs.

The report, drawn up jointly by the Nuffield Trust and King’s Fund think tanks, suggests that NHS England introduces a brand new contract ‘in parallel to the GMS contract’ to incentivise GPs to form networks or larger groups to provide services to improve mental health, elderly care and social care.

It admits that GPs will need new ‘funding options’ in order to take on such a wide range of new services, but says that the profession should should be tasked with taking ‘collective responsibility’ for population health and social care across networks of practices.

It also recommends that patient records should be accessible to pharmacists and social care to boost integration of services, and suggests a pot of money is set up for GPs to have some time away from seeing patients so they could plan care better.

The report was welcomed by Monitor, which recently launched a probe into GP services and said it would meet with the authors to discuss their recommendations.

NHS England said the report was ‘helpful’ in informing its call for views on primary care provision as part of its longer-term strategy for the NHS under the Call to Action banner.

The report comes after the Government launched a drive to better integrate care in England, with care minister Norman Lamb announcing a new ‘pioneer site’ scheme earlier this month. The Government has set a deadline for services to be fully integrated by 2018.

It calls for a ‘national framework’ to guide the future of general practice and recommends that GPs are given the confidence to ‘scale up and transform’, although it admits under current structures practices will struggle to do this.

The document recommends: ‘A new alternative contract for primary care is required, in parallel to the current GMS contract, setting objectives and parameters, but not specifying details of local implementation.’

‘The contract needs to be crafted by NHS England in a way that encourages groups of practices to take on a collective responsibility for population health (and ideally also social) care across the network of practices.’

‘The extent of services for which risk would be assumed would depend on the size of the population covered, scope of services for which the network was responsible, and would likely include: end-of-life, long-term conditions, mental health, older people and children’s care.’

As an interim measure, the report added, CCGs should also be delegated responsibility to commission a much wider range of services from general practice locally.

Judith Smith, director of policy at the Nuffield Trust, said that the move would mean practices providing a much greater range of services than seen under PMS, and taking on a greater level of risk.

She told Pulse: ‘In calling for an alternative contract we are suggesting something of a different magnitude. Specifically, one that is about a group of practices or a primary care organisation taking on a capitated population-based contract, and sharing risk for health - and ideally also social - care across the network of practices.’ 

‘It is critical that such a contract would specify outcomes and not the detail of local implementation - primary care networks and organisations need the freedom to craft the services and organisational arrangements that suit their local context.’

What the report recommends

1. A new alternative GP contract to encourage GPs to form larger-scale outlets

2. That NHS England sets out a national primary care framework to underpin this direction

3. Monitor should look at whether there are any regulatory barriers discouraging GPs from forming ‘super-practices’

4. Electronic patient records should be shared across the health system, also including pharmacists and social care

Source: Securing the Future of General Practice, July 2013

Dr Richard Vautrey, GPC deputy chair, said: ‘The problem is that individual practices are under so much workload at the moment that they don’t have the time or the space to actually engage in these sector-wide agendas. So what we need is to focus on how we take that pressure off practice to allow them that time and space that will naturally allow them to engage with the thinking, rather than lumbering them with more reorganisation and administrative chaos.’

‘What is needed is new resources to support and enable practices to make this shift and I do think resources generally need to be shifting into the community so practice can do more over and above what they are already doing which is seeing patients in their day-to-day practice.’

But a NHS England spokesperson welcomed the ideas in the report, saying: ‘There are increasing examples of general practice adopting new models of primary care to support more integrated care for patients and a more proactive approach to managing population health.’

‘These are described very well in the report and the “design principles” for successful scale will be especially helpful for providers who wish to consider whether federation or merger is the right thing for them and their local communities.’

Meanwhile, Monitor confirmed that it will be meeting with the report authors next week to discuss the findings further.

A spokesperson said: ‘We have a close working relationship already and [the report] touches on a lot of the issues that we are keen to look at and get views on. Finding whether there are barriers to practices coming together and working together, that is what we want to know about.’