Trusts ‘likely’ to run general practice under neighbourhood model, BMA warns

The prospect of secondary care running general practice ‘remains likely’, the BMA has warned, as it urged GPs to request meetings with local trusts and ICBs and seek out further details around the development of the neighbourhood model.

The roles of PCNs and GP federations within the new model ‘remain unclear’, creating ‘considerable uncertainty’, the union said in new guidance.

It urged GPs to request meetings with local NHS trusts and ICBs to seek details of their plans around integrated health organisations (IHOs) and neighbourhood models, including what governance arrangements they plan to deploy.

It comes as some ICBs have already chosen trusts – rather than GP practices – to lead their neighbourhood models.

Trusts will have commissioning responsibilities for primary care under the Government’s neighbourhood health framework, and have also been asked to signal their interest in taking over GP practice premises currently owned by NHS Property Services.

It said: ‘The BMA remains clear that the prospect of secondary-run general practice is an enormous risk and would pose an existential threat to the partnership model of general practice, as well as to the vital continuity of care and value for money it provides.

‘Likewise, the BMA is deeply sceptical of the capacity for secondary care organisations to effectively lead the organisation of primary care and general practice services they do not deliver or fully understand.

‘On this basis, the association remains strongly opposed to the development of integrated health organisations and to the multineighbourhood provider model.’

It is ‘especially important’ that GPs have ‘key roles’ in the development and leadership of any neighbourhood structures, the union said.

The BMA added: ‘The [Government] framework fails to fully address or clarify the future of important elements of the existing structure of general practice, thereby creating considerable uncertainty for many GPs, including those currently leading PCNs and GP federations.

‘This only adds to wider concerns regarding the future of general practice and the partnership model in particular.

‘Despite this, the prospect of PCNs evolving into SNPs could, providing essential safeguards are secured, provide a more attractive alternative to the MNP model. Depending on its terms, this approach may also help to ensure neighbourhoods are GP-led, as the BMA has called for.’

Last week, one ICB announced that GPs in its area will deliver a new neighbourhood care model for patients living with severe frailty using existing PCN arrangements, following an agreement with the local LMC.

The union also said that the prospect for so many different approaches across England could ‘present significant challenges’, particularly given ‘ongoing challenges’ posed by ICB restructuring and unclear leadership at a local level.

It said: ‘Without effective local commissioning of neighbourhood models, the proposed permissive approach could lead to unwarranted variation and post-code lotteries for patients, rather than the desired localised services.

‘This further emphasises the need for local GPs to lead the development and operation of neighbourhood services, using their expert knowledge of local populations and their care needs.’

The BMA previously argued that GPs must take leadership roles withing neighbourhoods now, and it also warned that encouraging trusts to take over GP practice premises suggests the Government wants secondary care to lead neighbourhoods, rather than GPs.