Exclusive The GP contract needs more ‘flexibility’ to allow CCGs and local area teams to jointly commission services from practices directly on the ground, says the primary care chief at NHS England.
Dr David Geddes, head of primary care commissioning at NHS England and a part-time GP in York, told Pulse that a new primary care strategy due to be published in the autumn would look at how priorities set by health and wellbeing boards can be implemented with ‘wrap around’ services that include GPs, hospitals and community services potentially commissioned under a single joint contracts.
The proposals will come amid a raft of radical changes being considered for the GP contract, with Dr Geddes saying that NHS England was looking at reducing the proportion of practice income attributed to QOF, and moving away from annual contract negotiations with the GPC.
He added that some local ‘flexibility’ could be negotiated into the GP contract already, but that it would have to change to allow CCGs and local area teams to set out local contracts with primary care and other providers, such as secondary care, community services and mental health.
Dr Geddes said: ‘There will still be a national contract but the area teams and CCGs will be able to commission on a local level in response to local demand. It is particularly important for CCGs to be able to have flexibility so they can understand how to commission primary care and community-based services in a way which will be responsive to inequality issues which are often quite confined to small groups.’
‘NHS England needs to articulate what the outcomes should be and give a narrative for how we wish to bring things forward. There will be national solutions and then local ways for how these can be delivered. Localism will mean CCGs will work collaboratively with the area teams on how the national contract will be applied.’
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He added that the local approach would happen in conversation with all local commissioners of care, including local authorities, with priorities set out by health and wellbeing boards.
He said: ‘The approach that your CCG and local area team takes will be based on what the health and wellbeing boards sets out as being their priorities. Let’s say for example it is concerned about care for the elderly and how local authorities manage to coordinate their care and support with health services.
‘That could be CCG-commissioned services, i.e. secondary care, area team-commissioned services, i.e. primary care and local authority-commissioned services, i.e. community services which could be commissioned through a standard NHS contract as a wrap-around service which will be able to apply to providers of services.’
He added: ‘There is going to be a shift from necessarily thinking this has to be a primary care medical model into looking at more creative ways on some of the services in which primary medical care is in a position to be able to pick up some of the areas to be more integrated with local authorities. That is particularly important when looking at some of the challenges regarding the most vulnerable patients, the elderly and frail but also with mental health or learning difficulties. It is about how we as a community, not just a health community, tackle the inequality agenda and how we can better commission to lessen inequalities in outcomes which are still quite stark in the country.’
The news comes as the Department of Health this week launched plans for integrated care to be the norm in the system by 2018. Starting in September, integrated care ‘pioneer sites’ will see GPs providing joined up services with community, secondary and mental health care teams with the backing of the DH and under exemptions from current ‘system barriers’.
Dr James Kingsland, national clinical lead of the NHS Clinical Commissioning Community, and a GP in Wallasey, Merseyside, welcomed the move saying that he envisaged CCGs commissioning more local services from primary care based on local needs.
He said: ‘We will see a system when local area teams will be managing consistency in core services and then there will be localism to account for variance in the way primary care is delivered locally.
‘There will still be a national contract, but there will be a difference in what percentage will be negotiated locally.’
He added that the NHS needed to ‘get away’ from the idea of conflict of interest in CCGs. He said: We are trying to promote CCGs moving care from the hospital to the member practices. The only question is when you are preferentially referring patients to new for-profit organisations, and the local area teams need to monitor that.’
But GPC deputy chair Dr Richard Vautrey disagreed: ‘There is already a lot of flexibility in the contract with the ability to commission enhanced services. This will be the way CCGs, local authorities and NHS England can ensure practices receive additional funding to support new areas of work.
‘It is though important that all patients across not just England but the UK can be confident of getting the same standard of general practice and so a national contract that provides a comprehensive level of primary care remains very important.’