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Blurring primary and secondary care

Get a consult in to do a few sessions - sounds simple but our GP blogger, Dr Clive Henderson muses that its anything but.

The news that certain trusts have been given the go ahead to run GP surgeries suggests the lines between primary and secondary care are about to get very blurred. What happens to all the gatekeeper roles? Were is the purchaser provider split? Who funds the overall integrated full pathway care for a given population? Is it the GP commissioning consortium- which was supposed to cover the whole English population -or the NHS commissioning board?

So many questions.

What we really want in our area is for some consultants to work on a sessional basis in GP surgeries. Even paying them an hourly rate at double what a GP commissioner gets would represent a considerable saving on a tariff based, cost per case, £500/hr equivalent.

Trouble is which trust would release a consultant under those terms ? If we paid the consultants independently , would we have to go through the full procurement formal cycle and even then would we be transgressing the tariff rules?

What if the consultant was actually part of primary care ? Imagine a large partnership and the senior GP retires. That partnership may decide that what they would really like in order to effectively manage their case load was a half time salaried GP and a half time gynaecologist/ substitute most specialities here . The fundamental issue being to pick areas which do not require secondary care operating theatres or equipment unavailable in a primary setting. That may be all very well for a large practice but presumably that consultant could not see patients from other practices. What could smaller practices do to replicate this model ? What if these practices federated ? Could we have a range of sessionally paid consultants, working as part of primary care, seeing patients from within that federation? Or could we still use an APMS contract ?

Why don't we all know the answers to these fundamental questions?

Dr Clive Henderson is a GP and chair of Goole, Howden and West Wolds locality in Yorkshire

Dr Clive Henderson