GPs should relinquish their independent partnership status to work as salaried GPs for integrated care organisations, a leading think tank has proposed to make NHS care less fragmented.
A report from the Policy Exchange suggests partnered GPs be paid for the ‘goodwill’ of their practices – at a current value of £160,000 – to work for an ICO.
The right-wing think-tank – set up by Conservative MPs – looked at ideas to encourage ‘competitive integration’ in the NHS.
The Department of Health currently runs integrated health pilots at 16 sites across England, but this report encourages them to go further, bringing together primary, community and acute NHS services together and with a single budget for purchase and provision.
It recommends a pilot programme of ten full-scale ICOs covering a population of around 250,000 each, but warned that bringing GPs into ICOs was one of the major financial and legal hurdles given ‘they are essentially private contractors to the NHS’.
They concluded: ‘We believe that many GP’s currently practising under a partnership model might be encouraged to work on a salaried basis for the integrated care organisation.
‘The “price” for relinquishing their independent partnership status could be the value tied up in the goodwill of their practice lists.’
It goes on to state that it would ‘cost the Government nothing’ to let GPs to trade the goodwill of their surgeries – something which would currently be against the law.
And salaried GPs might be attracted to work for an ICO by bringing their salaries more in line with their partnered colleagues.
Henry Featherstone former head of health and social care at the Policy Exchange and report author said the NHS was fragmented and full of perverse incentives.
He said: ‘We need to take the opportunity to reorganise care and one of the ways you could do that is to allow GPs to sell the goodwill of their practice into the ICO.
‘To get ICOs up and running this is one of the options we need to consider.’
But GPC deputy chairman Dr Richard Vautrey said they would oppose any such change as while it would benefit current partners ‘it would mark an end to general practice as we now know it’.
He added: ‘We would also vigorously oppose moving to all GPs being forced in to a salaried model.
‘This would be the ultimate privatisation of primary care and would see the end of GPs being independent advocates for their patients. It is exactly what patients would not want to see.’
Dr Johnny Marshall, the interim partnership development director for NHS Clinical Commissioners, said he backed the calls for ICO pilots so that models of care could be properly assessed.
But on the issue of GPs giving up their partnered status to join an ICO he stressed that was just one possible option.
He said: ‘We do need a debate about the potential models and how GPs feel about it.’
- Pilot programme of 10 full-scale ICOs each covering population of 250,000 equating to 5% of NHS capacity
- Overhaul of QOF and Clinical Excellence Awards to incentivise joint working, eg, reducing admissions
- Work to calculate the current healthcare-related costs of the most common long-term conditions and adding services such as diagnostics and treatment to NHS Tariffs.
- A framework developed to enable financial pooling arrangements between purchasers and providers to work in a virtual model of integrated care.