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GPs to offer ‘step-down’ beds, homecare and counselling as NHS England reveals details of radical new model for practices



GP practices have been invited to prepare bids for a £200m fund to implement the new models of care contained in NHS England’s Five Year Forward View – with applications due by 9 February.

In guidance issued to practices, NHS England said that bids to become ‘multispecialty community providers (MCPs)’ would have to show plans for providing ‘step-down’ beds, homecare, counselling, dentistry and district nursing, among others.

The Government has set a £200m ‘transformation fund’ for practices to become MCPs, which will ‘employ or partner with acute specialists including consultant geriatricians, psychiatrists and paediatricians’.

In its first detailed indication of what the new model will include, NHS England said MCPs will be expected to hold lists of at least 30,000 to 50,000 patients but ‘could be larger’.

However, it has set a deadline of 9 February, having only released the guidance this month, which itself has been moved back from 2 February.

Successful applicants, to be chosen by NHS England and Monitor by early March, will be eligible for a slice of the £200 million fund set aside to kick start new models of working in 2015/16, as well as leadership advice and support.

NHS England has specified that MCPs will:

  • Manage a new type of capitated contract for population health and care that encompasses the wider range of services directly provided for registered patients
  • Provide core GP services and community NHS services, for example district nursing, dentistry, pharmacy, mental health counselling, homecare and ‘step-down beds’ (for patients discharged from hospital but not quite ready to care for themselves at home)
  • Have a joined-up electronic health record for their registered population
  • Identify the most at-risk patients and give them intensive support
  • Employ or partner with acute specialists including consultant geriatricians, psychiatrists and paediatricians
  • Be expected to improve early cancer diagnosis
  • Potentially provide in-reach services to other settings of care, for example into care homes or services within local community hospitals, or providing some services within, or conceivably even running sections of district general hospitals. This could involve GPs with admitting rights within hospitals.

NHS England said this was clearly defined so the ‘vanguard’ sites could be ‘prototypes’ to replicate elsewhere when the trial finishes.

The plans also underlined that NHS England is hoping that these new models will solve the issue of providing GP services to patients in under-doctored areas.

The invitation said: ‘We are seeking bids from individual sites as part of the application process. We will also work with vanguard sites to develop support packages and, where required, business cases for transformation funding where to cover non-recurrent costs. For example, this transformation funding could be used to cover the double-running costs, capital projects or to fund dedicated implementation teams, potentially over several years. Local areas will be expected to make a contribution to transition costs.’

Commenting on the guidance, GPC deputy chair Dr Richard Vautrey expressed concern that the larger providers would end up competing with one another, rather than improving the overall provision of service.

He said: ‘We’ve seen this and we have been consistent in our view as we’ve promoted network development that one size will not fit all. There are many ways that practices can sensibly work together to deliver a more integrated and collaborative model of working within a locality. However, NHS England needs to be doing more to prevent this leading to greater fragmentation of services and an increase in a postcode lottery of services for patients.

‘There is also a risk that bodies are created that simply end up competing with one another rather than focusing on improving the provision of services in their own area. Already there are worrying signs that some CCGs are reluctant to commission from networks in their area because of fears of conflict of interest. There is also a potential that all that happens is that commissioners shift risk and costs to networks rather than resource them properly. The GPC is engaged in developing resources to support practices and networks to navigate their way through these potential problems.’

But Wessex LMCs chief executive Dr Nigel Watson said: ‘It is clear we are not going to get additional funding into our core contract [so] this is an opportunity to develop services, make general practice have a sustainable future [and] create new career path. Out-of-hospital care is the key area [in the NHS] that needs to be addressed.’

NHS Alliance chair Dr Michael Dixon warned there was ‘not a level playing field’.

He said: ‘My concern at the moment is that there is sufficient funding and support for practices to develop MCPs and a bit of a concern that in a way the PACS model, which if you like is a hospital-initiated model, will be simpler and more easy to put into operation simply because hospitals have the history, background and resource to do that and therefore a lot of my work at the moment is trying to ensure that there is a level playing field.’