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First GP practices to ditch national contract will sign local deal next year



Exclusive GPs in Manchester are the first to be offered the chance to ditch the national contract and become part of large organisations that could eventually run services for the whole local population.

A new contract is being developed by local authorities, CCGs, other NHS organisations and LMCs in Greater Manchester, which will see groups of practices beginning to form single legal entities from April, with a view to signing new contracts in the future.

The document announcing the changes said that ’a key part of this will be our aspiration to become an early adopter’ of the new national contract announced by Prime Minister David Cameron in October.

One proposal being discussed in Manchester involves an offer for GP partners to be bought out of their premises.

Under the plans, GPs will eventually jointly run ‘local care organisations’ alongside hospitals, which will cover populations of more than 200,000 people and will see savings made from primary and secondary care shared.

Crucially, the new organisations will not be required to run seven-day routine GP access under the new contract, with a separate contract set to cover this.

Mr Cameron’s announced that the national voluntary contract will begin in April 2017, and will see practices ditching QOF and running seven-day services.

However, the new proposals in Manchester represent the first indications about what the new voluntary contracts could entail.

Proposals currently under discussion include:

  • GPs taking on responsibility for managing a new type of capitated contract for population health and care that encompasses the wider range of services it directly provides for patients;
  • GPs potentially providing services in other care settings, including running sections of district hospitals, care homes and allowing GPs to admit patients directly to hospital;
  • Practices employing or partnering with acute specialists, such as consultant geriatricians, physiatrists, and paediatricians to provide specialist care in the community, and ‘hospital generalists’ to coordinate care for patients with long-term conditions;
  • Redesigned and improving access to community urgent care services;
  • Joined-up electronic health records for their populations.

Practices will look at forming larger legal entities in shadow form from April next year and will begin signing new contracts from November and December next year. 

The new organisations will initially form multispecialty care providers, as envisaged by NHS England chief executive Simon Stevens in the Five Year Forward View.

The plan will be for MCPs to be contracted from ‘local care organisations’ [LCOs], which will cover populations of more than 200,000.

These LCOs could even eventually encompass hospital trusts, and will become responsible for those secondary care services best placed in a community setting.

Dr Tracey Vell, chief executive of Manchester LMC, has been involved in the proposals.

She said: ’The ambition to transform primary care in Greater Manchester has brought some voluntary options for general practice to facilitate this. This has been discussed by GP leaders, federations and CCGs and views from community providers have been sought.

’This is an ambitious programme that will be closely linked to national developments. Practices will be offered help to transform their working lives and the health of their population.’

She told Pulse: ’The chief officer of the devolution system, Ian Williamson, said we are planning an estates buy-out, a central buy out. And that would include buying out GP practices at the going rate.’

Dr Vell added: ’What we want to do is make sure that the LCO is an interface between secondary care and primary care, so that what we save in primary care, from reducing attendance at secondary care, comes in to the same organisation.

’That’s really the problem at the moment – we’re not connecting secondary care with primary care, so savings aren’t reinvested. That vehicle, the joint venture, the LCO will be a way of bringing that saved funding into investments in primary care.’