Exclusive GPs are being excluded from contracts for enhanced services unless they form wider groups, a Pulse investigation has revealed.
Pulse has learnt that contracts – including enhanced services – in some areas were being offered only to GPs working in networks, covering services such as drug misuse and spirometry, as well as evening and weekend opening, making it even harder for single-handed practices to survive.
The GPC said that although it supported collaborative working, CCGs should not be taking a ‘top-down’ approach in making member practices federate together in order to receive funding.
NHS Southwark CCG in south London said it was planning to commission a service for drug misuse and one for population health, including smoking cessation, which it said were ‘required to be delivered on a collaborative basis’.
In the FOI response, it said: ‘NHS Southwark CCG is currently in the process of procuring two contracts that are required to be delivered on a collaborative basis.’
When asked whether a single practice could provide the services, the spokeswoman said: ‘No. All GP practices in Southwark have worked together to form neighbourhood groups. Our process took account of national NHS competition and procurement guidance. Conflict of interests are managed in accordance with our Conflict of Interest Policy.’
It also said it was in the final stages of setting up a diagnostic quality spirometry service with two groups of GPs, one consisting of 25 GP practices and the other of 21 practices. These are three-year contracts worth approximately £80,000 per year.
In Bury, the majority of practices form part of one 26-strong federation but seven practices still remain outside – four of which have now applied to also join.
Bury CCG decided to let the federation provide extended access on evenings and weekends using ‘winter money’ from NHS England for easing pressure on A&E departments.
A spokesperson said: ‘The delivery of the additional services covered only a 10-week period and the level of mobilisation required to deliver to the whole population (circa 200,000). The short timescale available meant that commissioners had to approach organisations with the capacity to provide 90 hours of GP time per week at one week’s notice.’
‘All practices were involved in drawing up proposals in their commissioning role and sector commissioners were aware of the invitation to bid and the successful outcome.’
As Pulse has already revealed, the chair of Newham CCG in east London said that practices will be unable to compete for enhanced services unless they federate.
Dr Zuhair Zarifa said: ‘I think primary care as it stands cannot carry on working under the current arrangement. We need to work together and we need to work very quickly. The message that will be going out from the CCG to the practices now, primary care now, is that you have to belong to a federation, some arrangement [of working together]. You have to start to talk.’
Meanwhile, other CCGs have indicated they are looking closely at commissioning more services to federations.
East Surrey CCG said it was ‘undertaking a review of its primary care services’ and federation working was ‘likely to be a consideration’, but added the overriding criteria was the ‘enhancement of patient quality’.
The model of federating has been recommended by NHS England, most recently in its emerging findings from the ‘Call to Action’ consultation, while the BMA, the RCGP and leading health think-tanks have also recommended GPs to work jointly to deliver services.
However, GPC deputy chair Dr Richard Vautrey warned CCGs against taking too much of a ‘top down’ approach and let GPs themselves decide whether or not to federate.
He said: ‘This shows the inherent problem with the current fragmented system in that many of the GPs involved in CCG leadership roles are the same GPs who would want to lead and shape general practice provision.’
‘Federations and networks should be developed when and where practices feel it would add value and not be a CCG top-down process. However it would be appropriate for CCGs to offer support to developing networks.’
‘GPC published guidance relating to federations and networks last year, giving advice relating to the different models that could be used but making it clear that there is no one size that would fit all.’
Dr Laurence Buckman, former GPC chair and a single-handed GP in north west London, said he was joining a formal federation of 28 practices.
He added: ‘Will everyone federate? I don’t think you can give a blanket statement because federations mean different things to different people [but] to be totally on your own, in the modern, post-CCG world, I think that is going to be very difficult.’