GPs will be offered ‘simple and attractive’ conditions to encourage them away from the national contract and join the ‘new models of care’ that are being tested across the country, say NHS bosses.
NHS England says that practices will be offered a ‘reimagined and simplified’ QOF and explicit ‘rights of return’ back to the national contract, under the plans published today.
The document published today details the next steps for setting up the GP-led multispeciality community providers (MCPs) and hospital-led primary and acute care systems (PACS) that are designed to better integrate care.
It reveals that there will be a ‘new payment structure’ that will see GP, community and – potentially also secondary care – budgets pooled together and given to the new organisations, which will be based on capitated payments.
It says: ‘The MCP model is based on a GP registered list. The structure will build in additional community and mental health services and social care as appropriate, converting these into an amount per patient that can be combined with core general practice funding.’
But it admits that one of the ‘most complex issues’ will be how the new organisations will incorporate GP budgets and persuade practices to opt out of the national GP contract.
The document said: ‘One of the most complex issues for the programme to deal with – both for MCPs and PACS – will be developing simple and attractive options for existing GP practices to migrate from their current funding and contractual arrangements, including ways to enable “rights of return”.’
It mentions that these new conditions could include a streamlined QOF with all existing quality payments for hospitals and GP practices being ‘reimagined and simplified in order to create aligned, whole system incentives that support new care models’.
It comes as Pulse today revealed that commissioners in one CCG are already looking at merging non-core GP funding with secondary care incentives.
The Five-Year Forward View was released last year by NHS England chief executive Simon Stevens, calling for integration between primary and secondary care under the new organisations.
However there have been concerns that GPs risk being ‘devoured’ by hospital trusts that will leave GPs disenfranchised.
This document marks the next stage of formalising arrangements for the new MCP and PACS organisations, with each one being given financial support of up to £8.3m.
The report added: ‘We are developing: model role definitions for new types of worker; common evaluation metrics; a single simple method for capitated pricing for a PACS and an MCP; a standard MCP contract perhaps with modular elements; new organisational forms; or “rights of return” for GP practices.’
Louise Watson, national programme lead for MCPs, told Pulse: ‘We’re working with the local MCPs, their GP clinical leaders, saying “what’s your model of care? How do you want this to be best designed to suit your local circumstances?” So we’ll pull in the national contract team to work with them.
‘And where there are common themes we’ll say “would you work with other vanguards, would you work with like-minded GPs and practitioners to develop what this looks like going forward.” Nothing is prescribed.’
GPC deputy chair Dr Richard Vautrey said: ‘With numerous practices large currently experiencing big cuts to their core funding through local PMS reviews, many GPs will understand the reality about how short term local enticements can very quickly turn sour.
‘The best way to deliver consistent high quality patient care and maintain both security and the solid foundation of a core contract that can then be built on with local additional funding and flexibility, is for NHS England to work with GPC to deliver an attractive, low bureaucracy and properly funded national contract.’