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GPs team up with hospitals to take over health budgets for 200k patients

Two areas of England are at the forefront of a revolution seeing GPs signing agreements with hospitals to jointly control integrated health and social care budgets.

Hammersmith and Fulham GP Federation has signed a partnership agreement with four trusts in the first step towards creating an ‘accountable care system’, which will see all five providers decide collectively how the local health budget should be spent.

The move comes after NHS England announced that all health and social care organisations that drew up plans in 2016 to overhaul care in England will eventually become accountable care systems (ACS).

NHS England’s Next Steps on the Five Year Forward View delivery plan has said that hospital trusts, CCGs and local authorities in the new ACSs will ‘take on clear collective responsibility for resources and population health’.

Dr John Sanfey, medical director of Hammersmith and Fulham GP Federation, said the new model of care would see GPs involved in funding discussions about primary, secondary and social care.

He said: ‘The real benefits longer term are to do with primary care and secondary care each functioning very efficiently and complementing each other so that things that are best done in primary care are done in primary care but are properly funded.’

Dr Sanfey said the budget for the population of 212,000 has yet to be finalised but could be between £200m and £300m.

He added that, while the benefits of the new model ‘have yet to materialise’ for primary care on the ground, GPs are already leading the partnership ‘in chairing roles in the important committees’. 

The partnership is aiming to sign an ‘alliance agreement’ in April before beginning ‘the serious business of how we share resources between primary, secondary and some aspects of community care’.

He said the providers are unsure they will ‘ever reach the “fully integrated” contract’ where GPs give up their national contract, but he said they aim to reach a partially integrated agreement in 2019.

GPs in Nottingham are also in talks with the four local CCGs to create a partially integrated ACS, which Nottinghamshire LMC has said will see GPs form part of the ‘governance of the accountable care system’.

Michael Wright, chief executive of the LMC, said Nottingham practices don’t ‘have the appetite’ to move away from their national contract, adding that ‘there isn’t a compelling case to move away from that at all’.

He said: ‘You might get a few who feel desperate or feel they just want to get out of a partnership and just go into a different kind of working arrangement and some of them it might appeal to but I would suspect that the overwhelming majority will want to hold on to their own contract.’

Pulse has previously reported that GP practices that decide to leave a ‘fully integrated’ accountable care contract could be forced to give up their patients.

The BMA has previously warned GPs ‘not to feel pressured’ to sign these contracts, with GPC contracts and regulations lead Dr Robert Morley adding ‘wholly inadvisable’ to suspend a GMS or PMS contract.

However Mr Wright added that the plans are still in the early stages with the LMC in talks with practices over how the ACS can best benefit GPs.

He said: ‘The intention is that, to really make an ACS work, then general practice, being such a crucial part of the system, has to tick some of the boxes that at the moment aren’t being ticked for general practice.’

NHS England’s move towards ‘accountable care’ 

Simon Stevens first announced that ‘sustainability and transformation partnerships’ would receive ‘governance rights’ in February last year at the Public Accounts Committee (PAC).

NHS England then announced nine ‘likely candidates’ to become the first ACSs, including Nottinghamshire and Manchester.

The ACS in Manchester, which saw GPs invited to bid for a £6bn contract to oversee all non-acute care, has meant GPs are able to hire paramedics to take on nearly all home visits, freeing up time for GPs to offer half-hour appointments.

However, other areas have also announced plans to form ACSs including Portsmouth and Leicestershire, where GPs criticised the plan for containing ‘no detail’ on GP involvement.