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NHS England in talks to set up ‘complex care’ GP practices

Commissioners are being encouraged to pitch models of GP practices dedicated to caring for complex and vulnerable patients, under plans being discussed by NHS England, Pulse has learned.

Speaking at the Long-Term Conditions 2014 conference in London today, Dr Martin McShane, NHS England director of long-term conditions, affirmed his commitment to setting up dedicated practices serving a list of around 400-500 patients drawn from local practices, which would receive more intensive care from a GP-led multidisciplinary team.

Dr McShane, a former GP, said his ‘lightbulb-moment’ concept – recently described in a blogpost – could help shift care out of the acute sector and into the community and address the ‘care gap’ he has observed opening up between primary and secondary care, as hospitals become increasingly specialised while GPs are faced with delivering ever-increasing workloads under a tightening budget.

NHS England will be considering piloting the ‘complex care’ practices, but Dr McShane said there was ‘nothing to stop’ commissioners setting up PMS or APMS contracts immediately if they wanted to.

Speaking to Pulse, Dr McShane said: ‘[This model] has been proven in other areas – CareMore and the “extensivist” model in the USA demonstrated that by dedicating resource and focus on that group of patients with complex needs, you reduce emergency admissions, length of stay and improve quality of life.

‘But you have to have the right sort of funding model for it. If you took a group of five or six practices, [they may have] a number of patients that they might want to dedicate support for a complex care practice.’

Dr McShane insisted NHS England was taking a flexible approach and encouraging commissioners and GPs to come up with models that suited their local healthcare populations and would not be imposing new services.

He said: ‘If you look at the planning guidance – look at the signals in that – we’re trying to create more flexibility and opportunity for people to try different service models. There’s some work going on in NHS England and we’re looking at whether we could support that.

‘It will be asking people to come back to us with models, flagging this up as a concept for people to think about. What I’m not going to do is start imposing Darzi centres on every CCG round the country – the solutions need to be owned, created and forged in the communities because Birmingham, Barnsley and Basingstoke are all completely different places with different cultures, history and relationships so they need to co-create this themselves.’

Dr McShane said GPs only need be involved if they are interested in focusing on patients with long-term conditions, but said the project would require a much more intensive, multidisciplinary approach than had so far been attempted through care planning approaches in the community up to now.

He said: ‘It may not be that they all come from GPs, it may be that some specialists may want to relocate into the community,’ he said. ‘If a generalist has an interest in becoming dedicated to that sort of work they may wish to do that, but it’s not exclusive to anyone. But I think it needs to have all the professions involved. I think that’s one of the problems we’ve had with complex care, the medical profession in the community has said, oh nurses can lead it – but we also need the medical input.’

Informal discussions about the concept with groups such as the RCGP had been positive, Dr McShane said, although he stressed the College had not formally backed the proposal.

He said: ‘I’m taking soundings and when I talk to people about this concept, they say yes that’s a good idea. I think the devil is in the detail and that’s why we need to people on the ground to work [that] out.’