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GPs on new contract may face financial penalties for dissatisfied patients

Practices signing up to a new voluntary GP contract may have financial penalties applied if their model does not improve population health locally, or patients are unhappy.

NHS Dudley CCG – one of the six areas in England piloting ‘new models of care’ in April 2017 – has launched a public consultation on its new multispecialty community provider (MCP) contract, revealing that 10% of funding will be linked to health outcomes and patient satisfaction.

However, it also adds that penalties will be applied if targets are missed.

This is the first local area to publish its consultation on the new contract, after NHS England published its draft national plans for the new voluntary contract framework last week, revealing that GP practices that fully sign up will see their funding decrease if they fail to reduce admissions

The voluntary contract will be for MCPs, the new models of care that will be led by GPs and provide primary and secondary care services to populations of above 30,000.

The national framework will form the basis of it, but local areas will be able to adapt it as they wish.

The NHS Dudley CCG consultation document says the CCG ‘would expect providers to deliver care to a defined set of outcomes and will have an incentive of extra payment if they reach these and penalties if they don’t’.

The consultation says the MCP ‘will have a part of its funding allocated by the CCG based on its achievement in the following areas: how satisfied patients are with the MCP services, the health outcomes for patients using MCP services, and the general health of the local population’.

It said outcomes would also be related to:

  • cutting referral waiting times for services to be delived within the MCP to 3-6 weeks (by 2020);
  • increased monitoring for people with asthma, diabetes and heart diseases;
  • end of life care coordination;
  • reducing rates of smoking and obesity and improving life expectancy;
  • patient satisfaction and patient self reporting on whether the MCP helped them with things like pain reduction, increased mobility, better mood and better control over your own health;
  • staff satisfaction and ‘ensuring that the MCP is a great place to work’. 

It describes the MCP as ‘a new single organisation that is responsible for bringing together local GP practices, nurses, community health and mental health services, social care, hospital specialists and others to provide integrated out of hospital healthcare’.

It will also have a single telephone and online system that all patients can use to access different local services’.

NHS Dudley CCG is leading on the work to develop the ’All Together Better’ MCP in Dudley, formed of its 20 member practices and aided by a £4.4m funding injection from NHS England’s new care models programme in 2016/17.

When it goes live, it will have a capitated budget based on the 315,000-strong patient population of Dudley. Providers will be told the full ‘scope’ of the services to be included in the MCP contract later this year, the CCG adds.

The new models of care were announced by NHS England in its Five Year Forward View in October 2014, designed to provide primary care and secondary care in a single organisation.

Then Prime Minister David Cameron announced his new outcomes based GP contract last year, saying it would include seven-day access and be offered to practices or federations covering at least 30,000 patients.

NHS England’s definition of a multispecialty community provider (MCP)

NHS England’s board paper says MCPs will ‘combine the delivery of primary care and community based health and care services’ including ‘planning and budgets’ while also incorporating ‘a much wider range of services and specialists wherever that is the best thing to do’.

Key features of the ‘fully integrated’ MCP model include:

  • Holding a single whole population budget across the range of services it provides, based on the GP registered list – the MCP covers the sum of the registered lists of the participating practices, plus the specified unregistered population;
  • Built around ‘care hubs’ of integrated teams, each typically serving a community of around 30-50,000 people (but NHS England says that all the 14 MCP vanguards now serve a minimum population of around 100,000);
  • A place-based model of care which serves the whole population, not just an important subset such as people over the age of 65;
  • Operates at at the whole population level, aiming to ‘bend the curve of future healthcare demand’ by addressing ‘the wider determinants of health and tackle inequalities’;
  • Builds a ‘coherent and effective local network of urgent care’ for people with ‘self-limiting conditions’;
  • Provides ‘a broader range of services in the community that are more joined-up between primary, community, social and acute care services, and between physical and mental health’ for people ‘with ongoing care needs’;
  • Delivers an ‘extensive care’ service for ‘small groups of patients with very high needs and costs’.

NHS Dudley CCG says its MCP will deliver the following services:

  • community based physical health services for adults and children;
  • some existing out-patient services for adults and children;
  • urgent care centre and primary care out of hours service;
  • primary care services (ie: GP services) provided under existing contracts
  • all mental health services;
  • all learning disability services;
  • intermediate care services and services provided for people assessed as having NHS Continuing Healthcare needs;
  • end of life services;
  • voluntary and community sector services.

Source: NHS England board paper and NHS Dudley CCG consultation