Exclusive GPs in one area have signed a groundbreaking new-style contract with payments based on shifting large amounts of elective care from the local trust into the community.
A GP provider company representing 93 practices in Leicestershire has won an ‘alliance contract’ jointly with local trusts as part of a plan to shift 40% of dermatology and 30% of ophthalmology outpatients out of secondary care, as well as improving integration of services and reducing costs.
The contract – put out for expressions of interest last year – is thought to represent the first operational ‘alliance’ contract between primary and secondary care.
GPC has welcomed the move to integrate services, but some GPs have warned of possible conflicts of interest in practitioners potentially ‘considering private concerns’ of targets to reduce hospital activity when making referral decisions.
The alliance contract, commissioned by NHS West Leicestershire CCG and NHS East Leicestershire and Rutland CCG from 1 April and set to last for seven years subject to evaluations at the three-year and five-year stage.
The contract will see GPs being being measured on their performance in providing elective care alongside a local hospital trust – University Hospitals of Leicester – and a community care provider, the Leicestershire Partnership Trust.
Alliance contracts have been described by NHS England as potentially ‘transformational’ for the NHS have been hailed by academics as a potential way to achieve care integration to benefit patients.
Local GP representatives are supportive of the move, but said they feared a ‘lack of clarity’ over the financial risks and benefits to the GP practices involved.
Dr Chris Hewitt, medical executive director of Leicester, Leicestershire and Rutland LMC, said: ‘We are not clear what the risks are to the individual practices, the shareholders [in the GP provider company] and what the potential benefits are. At the current time with morale, cash flow and income issues we don’t want to see our members in a vulnerable position.’
‘The LMC is generally supportive of the direction but we are seeking details of what it means to the patients, the carers and the GPs.’
Dr Hewitt added it was ‘important that conflicts of interest don’t get in the way of patients receiving the best care’.
GPC member and retired GP Dr Ron singer, who chairs the Medical Practitioners’ Union of the Unite union, said: ‘There is an ethical concern, and there are conflicts of interests involved, because a GP’s job is to be an advocate of the patient in front of them, not to be considering private concerns.’
But West Leicestershire CCG chair Professor Mayur Lakhani said the concerns were unfounded. He said: ‘There is a very strong governance framework, very strong conflicts-of-interest policy, so this is governed entirely by the needs of patients.’
‘We are already seeing some improvements, for example [GP] practice-based physiotherapy and ultrasound. I think the model of working is encouraging and there is a lot of excitement about it. We have sorted the governance and the ethics, this is entirely defendable. I can understand why someone might ask the question, but I can completely say that is untrue.’
Services which may be better provided in GP settings rather than hospital under the contract included, for example, minor surgery, consultant clinics, ultrasound, rheumatology and dermatology, he added. He said: ‘We are already finding that more services are provided locally, in the doctor’s surgery, so I think it is a very exciting model.’
The LLR Provider Company – chaired by Dr Mohamed Roshan, a GP the Willows Medical Centre in Leicester – was unavailable for comment, but said in its April newsletter: ‘From the 1 April 2014, LLR NHS Partners have taken over from Derbyshire Community Health Services NHS Trust (DCHS) which has provided the elective care services in LLR for the last three years.’
‘LLR NHS Partners now provide services including outpatients, day case surgery, diagnostics and community paediatric services across LLR community hospitals. In addition we will make best use of clinical resources, including primary care accommodation and other flexible, elective and diagnostic services ensuring wider patient choice.’
GPC chair Dr Chaand Nagpaul said: ‘Any model that allows GPs to work in a more integrated fashion with other services is good as long as it is based on sound principles and conflicts of interest have been addressed. It will be interesting to see how this model works but a frustration for GPs has been disjointed working with, for example, community nurses.’
‘What this shows is that it is entirely possible to look at ways in which GPs can work in collaborative ways without an need to tamper with the core GP contract. That is an important principle.’