GPs must not be pressured into signing up to neighbourhood proposals, says BMA

GP practices must not be pressured into signing up to neighbourhood proposals and should await further guidance before committing to any local plans, the BMA has said.

The union’s GP committee said that they are aware that ‘in many areas’ practices are ‘under pressure’ to agree to new neighbourhood models, with ‘little involvement’ in development of the proposals and a ‘significant’ lack of information on the impact that it will have on them or their patients.

In an update to GPs, the new GPC executive said that concerns have also been highlighted around funding and resources being taken away or linked to other local enhanced services ‘if they don’t engage with the neighbourhood agenda’.

It stressed that practices do not have to sign up to the new proposals, and promised new guidance specifically in light on the new NHS England consultation on the neighbourhood models.

It comes as every GP practice in one area has already signed up to a neighbourhood care model using existing PCN contract arrangements.

Last week NHS England launched an eight-week consultation on the proposed neighbourhood contract models, including further detail on what the contracts are expected to look like.

The GPC said: ‘We know that practices may be being asked to sign up to local proposals without clear commitments from ICBs and local systems around funding, workload implications, estates utilisation and use of patient data (which GPCE’s ongoing collective action has highlighted should be a particular area of concern for practices).

‘As the newly elected officer team for GPC England we are keen to make this a focus over the coming months and will be producing further guidance for practices over how to engage with these proposals in a way that protects themselves and their patients

‘In the meantime, we would like to reassure practices that they do not have to, and should not be pressured to, sign up to local neighbourhood proposals.

‘There must be full and meaningful engagement with practices and LMCs to ensure there is appropriate governance in place as well as ring-fenced budgets for key areas especially around resourcing left shift of work, protections around sharing confidential data and proper utilisation of estates.’

Additional documents published by NHS England as part of the consultation last week said that the single neighbourhood provider (SNP) contract is ‘an evolution’ of the PCN DES which local systems ‘can take forward at their own pace’.

Practices would have the option to remain in the PCN DES or ‘take up one of the other options if their commissioner proposes it’. 

The consultation proposes using the NHS standard contract with an additional ‘neighbourhood’ schedule for commissioning a multi-neighbourhood provider (MNP).

NHS England plans for MNPs to use their scale to ‘design and co-ordinate neighbourhood health services in their footprint’, which may include delivering NHS services directly at a larger scale than a single neighbourhood, or ‘filling in’ services within a single neighbourhood where it is locally agreed to be more appropriate for an MNP to deliver.

Commenting on the contracts consultation, Simon Appleyard, financial specialist for doctors at Wesleyan, warned the proposals ‘could significantly complicate how primary care services are contracted, funded and managed’.

‘With a new Prime Minister taking office, practices will understandably want early confirmation of whether these proposals remain a priority and whether the timetable or detail may change. GPs cannot make significant business and investment decisions against an uncertain policy backdrop.

‘Funding, liabilities and financial risk must remain properly aligned if the reforms are to give practices the confidence to invest and plan for the future.

‘That means providing clarity about how income will flow between multi-neighbourhood providers, single-neighbourhood providers and individual practices – and who will carry the financial consequences if contracted services are not delivered or cases of fraud or negligence arise.

‘That level of responsibility could be significant for a lead practice within a consortium. GPs need to understand whether they are being asked to carry additional financial and legal exposure while continuing to deliver exceptional patient care.

‘Any new model must strengthen, not undermine, the GP partnership model and the financial sustainability of individual practices.’

Pulse has summed up the plans and has also looked at what this vision for neighbourhood health and a new Prime Minister could mean for the future of GP local enhanced services.

Earlier this month, the newly elected BMA GP committee chair told Pulse that it is ‘completely necessary’ that partnerships are protected within the neighbourhood health model.

And a senior former adviser on neighbourhood health warned that the shift to neighbourhood health ‘will likely fail’ unless the new Prime Minister changes its current direction.