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GP funding to be pooled with secondary care under radical CCG plans

GPs could see their enhanced service and QOF funding pooled with secondary and social care budgets under radical plans being discussed by a CCG

NHS Somerset CCG – which has already successfully signed up the majority of practices in the area to a local scheme to replace the QOF – has outlined plans for all health and social care providers to move towards a ‘capitated outcomes-based and incentivised’ form of commissioning.

The move to pool CCG budgets with Somerset County Council and NHS England would be the first to include general practice in a pooled budget based on shared outcomes.

Commissioning leaders were unable to elaborate further on which GP budgets would be included, but local GP leaders told Pulse that there have been discussions about moving elements of the GP contract into the shared outcomes scheme.

The move to introduce ‘outcomes-based commissioning’ (OBC) follows similar models set up across the country, inlcluding the move to local authority-led commissioning of health and social care services in Greater Manchester.

The CCG’s business model for the plans stated: ‘General practice will play an important role in the move to [outcomes-based commissioning], but there are significant challenges to the full inclusion of primary care because of the nature of their contracts with NHS England and current demand pressures on the workforce.’

Its business plan put forward a series of recommendations, including:

  • ‘Agree in principle to future discussions to pool budgets for health and social care, subject to these proposals being reviewed and agreed at a future meeting.’
  • ‘Approve in principle a move to a capitated outcomes based and incentivised commissioning approach for health and social care services in Somerset.’
  • ‘Agree that the CCG via the clinical operations group engages further with primary care providers and NHS England to develop detailed options for practices to participate in OBC.’

The CCG’s governing body members approved the plans ‘in principle’ at the latest July board meeting in an attempt to secure over £200m efficiency savings required by NHS England over the next five years.

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Dr Harry Yoxall, medical secretary of Somerset LMC, told Pulse: ‘We’ve had very early conversations with the CCG and the area team about whether there are elements of the contract that could be included in outcomes based commissioning, but that would not put the core contract at risk.’

Dr Yoxall added that it would ‘make sense’ for GPs to be involved in an integrated, outcomes-based model, as ‘80% of NHS contacts take place in primary care, and GPs are able to intervene at an early stage’.

However, he said there was ‘no suggestion’ that the core GP contract would be affected.

Dr Yoxall said: ‘There is no suggestion at the moment that the core contract, the GMS or PMS, would be in any way involved with this – some of the peripheral contracting, some of the enhanced services for example, could reasonably be transferred into this new contracting model.’

A spokesperson for NHS Somerset CCG said: ‘The plan to introduce OBC contracts in Somerset from April 2017 does not include the creation of a single accountable care organisation across the county. It is based on two lots covering the east and west of the county and does not specify the form which providers might come together to work.’

‘Somerset CCG has not made a decision as to which elements of primary care funding will be included and is committed to further discussion with local practices before any decision is made.’ 

The CCG is seen as a trailblazer for new models of working and has caused ructions with the GPC over the past year after agreeing with the LMC and local area team that GP practices could ditch QOF work, replacing it with an alternative funding stream underpinned by broader outcomes measures shared across practices.