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GPs invited to hold contracts for acute care services



GP practices will be encouraged to get involved in new companies that will be set up to provide both acute hospital and GP care, NHS England has said. 

The new ‘primary and acute care services’ (PACS) framework sets out who can hold a contract for the organisations, which will provide primary and secondary care services, including acute services.

As well as an existing NHS provider, NHS England says that the PACS contract could also be held by a ‘new entity, formed for example through a joint venture between a group of GPs, an acute trust, and other local health and care providers’.

It had been previously feared that GPs risked being devoured by hospital trusts, where hospitals would run the whole organisations and employ GPs.

For the first time, the new framework makes clear that GPs will be able to run the organisations, including acute care services.

But GP leaders questioned whether GPs would want to hold contracts that made them repsonsible for acute services.

Family Doctor Association chair Dr Peter Swinyard told Pulse: ‘I’m absolutely sure that they won’t – some will understand why they should be providing it while others will see it as various shades of terrible’.

Other GPs have questioned whether integrating primary care with hospital acute care by setting up completely new companies is the way forward.

Dr Brian Fisher, a GP in south-east London, said: ‘It seems a particularly convoluted organisational form, where the overall aims may not be met,’ said Dr Fisher. ‘The idea of possibly GPs contracting hospitals, it is going to be very difficult to make that happen, and there will be all sorts of conflicts of interest.’

However, NHS England quashed  concerns about private healthcare providers becoming partners in a PACS, with a spokesperson saying that the likes of Virgin Care and Care UK ‘were unlikely’ to get involved in holding a PACS contract.

‘We are not saying that we have ruled it out but it would be very, very unlikely and we are not anticipating that to happen,’ said a spokesperson for NHS England. ‘As a partner or a sub-contractor further down the line perhaps but not as the main lead provider.’

The newly published framework is based on the results of nine integrated primary and acute care system pilot schemes. 

Structure of PACS model

The framework spells out three ‘voluntary’ PACS contracting models:

  • the ‘virtual’ PACS, where providers are bound together by an alliance agreement;
  • the ‘partially integrated’ PACS, where a contract is let for the vast majority of health and care services with a single budget;
  • the ‘fully integrated’ PACS, where there is a single contract for all local health and care services, operating under a whole-population budget.

NHS England says that the precise form of legal entity of a PACS will be for local determination. This could either be a contractual structure (such as a contractual joint venture) or a single organisation. This entity may, of course, sub-contract elements of the services to existing or new providers.

Options include:

  • an existing NHS trust or foundation trust taking a lead role across the system;
  • a limited company or limited liability partnership (LLP)- this could be newly formed as a corporate joint venture vehicle for the purposes of delivering the PACS contract;
  • a community interest company (CIC) – a company, bringing parties together with community interest values and using its assets to improve the care of the population.

Five crucial elements for success of the PACS model

  • A real commitment to partnership working between local providers so that GPs in particular genuinely feel they are full partners in the model;
  • A data-driven care model that organises care around population segments;
  • Integrated neighbourhood health and care teams, working at a population size of 30,000 to 50,000;
  • Flexible use of workforce and technology, that can disrupt existing ways of working and span organisational boundaries;
  • A contracting, funding and organisational model that is designed to deliver the population-based care model.

Source: NHS England’s ‘Integrated primary and acute care systems (PACS) – Describing the care model and the business model’