New 10-year plan contracts should not be created without GP approval, says BMA

New contracts announced as part of the 10-year health plan should not be created ‘without the approval and consent of GPs’, the BMA has told the Government.

In a response to an NHS England consultation on advanced foundation trusts, the union has opposed the introduction of integrated health organisation (IHO) contracts and has urged the Government to ‘listen to the concern of local GPs’.

There should also be contractual safeguards that rule out the possibility of NHS trusts holding patient lists in place of GP practices, the BMA said.

NHSE was consulting on a document outlining the introduction of IHO contracts as per the 10-year plan, which receive funding through ‘capitated budgets’ from ICBs – but the BMA warned that this could lead to advanced foundation trusts ‘dominating the healthcare landscape in some areas’.

As announced in the 10-year plan, IHOs will hold the whole health budget ‘for a defined population’, with more contracts to be awarded when the model officially goes live in 2027, and the Government has recently revealed a list of eight ‘advanced foundation trusts‘ which will be among the first to take on the new IHO contracts.

But the BMA warned that the introduction of IHO contracts ‘threaten to upend’ the GP partnership model and that there are concerns over whether IHOs will be have the capacity to manage local GP contracts while also having to deal with wider secondary care pressures.

It said: ‘The BMA is concerned about the impact that this would have, voting to oppose the introduction of IHOs and urging NHSE and the Government to reconsider its position on their establishment.

‘Instead, NHSE and DHSC should engage with the BMA to develop the necessary safeguards for GP contracts, and work with the BMA and LMCs to listen to the concerns of local GPs around the vertical integration of primary and secondary care.

‘These contractual safeguards include commitments that rule out the possibility of NHS trusts holding patient lists in place of GP practices, and ensure no resources are diverted away from existing provisions to GP practices.

‘The BMA opposes the creation of IHOs in general, and it is crucial that no IHOs are created without the approval and consent of local GP practices and LMCs.’

It opposed the new IHO contracts as they ‘lack the flexibility’ of smaller independent practices and will be potentially ‘conflicted with broader priorities’.

‘Therefore, IHOs likely will not be able to innovate and adapt as quickly, leading to a less efficient primary care landscape that does not meet the specific needs of each community as effectively,’ the document added.

NHS England has planned for these organisations to be designated this year, designing the IHO model during 2026/27, with the first contracts set to be awarded in 2027.

It comes after last month NHS England said that GPs could lead new neighbourhood provider structures, either solely or with hospital ‘alliances’.

GPs leaders recently voted in favour of ‘disengaging’ from neighbourhood provider structures unless they are ‘demonstrably led’ by general practice. 

One large ICB has already chosen a number of hospital trusts, instead of GP practices, to oversee the new ‘neighbourhood health service’ across its footprint, announcing that the trusts will also hold the funding.

The BMA has previously warned that trusts taking on neighbourhood contracts could ‘risk bankruptcy for GPs’.