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GPs could be incentivised to work under hospital trusts, reports claim


waiting patients


More GPs will be offered incentives to be directly employed by ‘academy-style’ hospitals instead of running their own practices as independent contractors under new plans from the health secretary.

The Times reported over the weekend that Sajid Javid is set to conduct a full review of general practice, including many GP practices being run by trusts.

There would be ‘no forcible state takeover’ of GPs, but they would instead be likely to be incentivised to join trusts, the newspaper said.

This is similar to the model in Wolverhampton, where nine local GP practices are currently run by the Royal Wolverhampton NHS Trust.

The Department of Health and Social Care denied claims by the newspaper that this amounted to general practice being ‘nationalised’.

In a letter to the Prime Minister, seen by The Times, Mr Javid said there are ‘considerable drawbacks’ to the current contractor system including an ‘underinvestment in prevention’.

It also said that the health secretary will launch ‘an independent review of the future of primary care’, looking at ‘workforce, business models and how GPs work with the other parts of the NHS such as hospitals’ with a view to ‘bringing together primary and secondary care’, The Times reported.

According to the newspaper, the plans aim to reduce hospital admissions by making GPs ‘do more to keep patients out of hospital’.

However, a spokesperson for the Department of Health and Social Care (DHSC) told Pulse it has ‘no plans to nationalise general practice’.

They said: ‘We are incredibly grateful for the phenomenal work that GPs do for their patients and have invested £520 million to improve access and expand GP capacity during the pandemic.

‘Now we have moved back to Plan A we will continue with our plans to tackle waiting lists and deliver the ambitious reforms needed to help our health and social care system recover.’

Responding to The Times’ claims, the BMA said it is a ‘kick in the teeth to read about our future in the press with no warning’.

BMA England GP Committee chair Dr Farah Jameel said: ‘Now is the time to invest in general practice, not to try and reinvent the wheel through a wholesale change to the model. 

‘The existing model protects the vital relationship between GP and their patient and allows for individual care, rather than a top-down approach which is what general practice might become under these plans.’

General practice’s ‘high-quality, cost-effective and timely care is underestimated and poorly valued by policymakers’, she added.

The RCGP said in a statement that although it is ‘open to exploring new ideas about the future of general practice’, there ‘has to be a very good reason for changing a model that works well for patients, for the NHS and for the taxpayer’.

RCGP chair Professor Martin Marshall said: ‘Looking into ways that the NHS can work more efficiently as a whole and can be sustainable for the future – and considering how primary and secondary care can work better together to ensure patients have the best possible experience and outcomes of the health service – is a necessary exercise. 

‘[But] it is one that must recognise the current model of general practice – whereby GP practices have independent contractor status – is one that delivers exceptional benefits for the NHS.’

What is happening in Wolverhampton?

In Wolverhampton, the local hospital trust has taken over the running of nine practices.

Royal Wolverhampton NHS Trust began providing GP services in 2017 when it announced it would be directly responsible for the delivery of care of eight GP practices as part of an ‘open-ended’ pilot. In 2019, it acquired its tenth practice, but Pulse understands one has also left the trust.

At the time, the trust said that the acquisition means it is able to ‘redesign services’ and prevent unnecessary hospital admissions.

It also said issues around ‘scope of responsibility, funding, differing objectives and drivers will be removed’ so that ‘clinicians will be in a position to design effective, high-quality clinical pathways, which will improve appropriate access and positively impact on patient outcomes’. 

Meanwhile, the Royal Wolverhampton NHS Trust and its GP practices have partnered with Babylon.

But Wolverhampton is not the only area where this is happening.

Also in 2019, an NHS foundation trust in Cheshire also took over three GP practices after partners were forced to hand over their contract over recruitment issues. 

And in the same year, Sandwell and West Birmingham Hospitals NHS Trust took over three GP practices, with GPs warning the takeovers could put the trust in an ‘extremely powerful position’.

Please note: This story was updated at 16:10 on 3/3/2022 to clarify that one GP practice had left the Royal Wolverhampton Trust, which manages nine practices at the time of writing.

READERS' COMMENTS [27]

ian owen 31 January, 2022 11:14 am

Or, you know, incentivise doctors to become GP’s instead of jumping on every Telegraph/Mail bandwagon. Actually invest in us. Maybe think about those missing GP’s we’ve been promised for ever?
No?
OK then

MULAYIL KRISHNAN Gopinath 31 January, 2022 11:17 am

Good idea. Take holidays when you want, go of sick when you want,no worry about complaints. What’s not to like about this plan ??

Valerie Jane Philip 31 January, 2022 11:33 am

Another nail in the coffin for well run practices primary care teams offering personalised care with continuity.
Incentivise newly qualified GPs to work for these ‘trusts’
An already difficult recruitment situation will get worse, especially in deprived areas (ironic that!)
Will practices be forced to merge into one amorphous blob?
Will patients have to travel further? What will happen re GP owned premises?
Practices will become unsustainable if they can’t recruit,so forced to relinquish their contracts.
We all know that much ‘prevention’ lies in reducing poverty, better education, lifestyle, environments able to facilitate better mental and physical health. NHS checks and the like, while important, barely scratch the surface.
I fail to see how these proposals will improve health and prevention.
Increased running and staff costs and the pandemic have severely stretched many practices. Ill thought out yet more reforms? And we thought Lansley was bad enough.
How about some investment in what works and what patients want instead?

Rogue 1 31 January, 2022 11:36 am

That wont change a thing – just create more meetings which will again take more time away from patients. If consultants start to have any say in how we run things I think the exodus will get even greater.
They need to invest and by that we need GPs ie:manpower and money, but I dont see either coming any time soon!

Valerie Jane Philip 31 January, 2022 11:48 am

Agree with Mulayil.
There would need to be a safe contract. Lots of ‘well-being’ time!
12 patients per session, 15 minute appointments, no extras, and there would have to be a huge sessional pool to fill gaps in rotas. Just do what you can in the time, continuity doesn’t matter, ‘come back next week and you’ll probably see someone else anyway’. Really good for elderly or people with LTC which is a huge part of our work ? I think not!
There is a big incentive in the partnership model already to get as much done in our 10 minutes, tick every box in sight while being holistic, patient centred, running late and taking the numerous ‘extras ‘ in way of phone consults, e-consults etc.
Maybe ‘the Saj’ doesn’t realise that there would be huge drawbacks to this.
Come on BMA RCGP ! General practice is on its knees. Let’s have a push for mor investment in what we know DOES work.

The Prime Minister 31 January, 2022 1:08 pm

I AGREE WITH 11.17 AM…..LET THESE “JERKS” CHANGE THE MODEL…..THEY ARE CONVINCED WE ARE ALL LAZY B’STARDS BUT WHEN THE COSTS COME THROUGH AND THE SERVICE COSTS 2-3 X AS MUCH THEY WILL BE THE ONES WITH EGG ON THEIR FACE…PLUS WE WILL START BEING TREATED LIKE HUMANS-WHEN I AM ILL, I WILL BE ABLE TO TAKE SICK LEAVE RATHER THAN KEEP SOLDIERING ON AND ALSO ANNUAL LEAVE WHEN CAN…….IT WON’T BE MY PROBLEM IF THEIR IS A STAFFING PROBLEM…..THE TRUST WILL HAVE TO SORT IT OUT AND GOOD LUCK TO THEM…..THE CURRENT SITUATION IS UNSUSTAINABLE……LAST DEBACLE IN 2004 WITH OUT OF HOURS WAS SIMPLY A CASE OF THE GOVERNMENT NOT BELIEVING MUCH WORK GPs DID HENCE UNDERESTIMATING THE COSTS AND BEING BITTER EVER SINCE AND GUESS WHAT…THESE DUMBOS WILL MAKE THE SAME GAFF AGAIN……

Nicholas Sharvill 31 January, 2022 2:00 pm

I thought the biggest reason for premature ill health was poverty and inequality rather than the way primary care is run.. levelling up so far has meant nothing as poverty is increasing
Admissions avoidance. Dont we already have the lowest rates in Europe?

Can a GP from Wolverhampton please comment on how the system works both as a career and for patients

Aman Samaei 31 January, 2022 2:19 pm

I think Saj javid is thinking to relax Gps as they too tired, needs some relaxation post covid tiredness syndrome. As others said, more time off work, holiday on time, A/L on time, no worries about staffing and paper work and trusts look after all, what can be better than this!
Thanks Saj
Good luck

Patrufini Duffy 31 January, 2022 2:20 pm

Bye Bye GPs – hello America.

David Evans 31 January, 2022 2:20 pm

Excellent idea; long overdue
HMO type of health care delivery with a UK flavour.

James Weems 31 January, 2022 3:20 pm

It seems the great work practices do for their patients is being ignored or at least being taken for granted. This cannot end well.

Thomas Rigby 31 January, 2022 5:35 pm

I think some of the doctors commenting above are looking back on their hospital trust employed junior doctor years with rose tinted specs. I don’t remember being able to have my annual leave when I wanted it. I remember missing loads of family events and bank holidays as I couldn’t swap out of rota’d shifts. I seem to recall 7 days in a row 12 hour night shifts with a post take ward round until lunch time, not enough time to drive home and back before starting that night, so having to sleep in the hospital accommodation, the jetlagged weekend before going back on days on the monday morning. Working 1 in 2 weekends in A+E, having to cover others illness whilst still doing own duties, whilst being paid less than the cleaners hourly rate… do you honestly think trusts will differentiate between day time , and out of hours GP services if this happens?

David Church 31 January, 2022 6:21 pm

I think the health Secretary has been misled !
GPs do our level best to keep patients out of hospitals, and to some extent it could be argued that we receive incentive payments already under CDM streams, for doing so.
Strangeley, a GP employed by a Hospital Trust (rather than a Community Trust or Health Board), would probably be under some pressure to refer patients into the hospital system, either as IP or as OP, because then the hospital would receive increased funding under the internal markets tarrif for them being ‘in hospital’ !
This perverse incentive would have the exact opposite effect to the stated intention, and it makes one think that this is not the real underlying reason they want hospitals (instead of Community Health Boards) to be running the local GP surgeries!
It absolutely would NOT save money. But the GPs might earn a lot more for an easier time…..

Wendy Domleo 31 January, 2022 7:31 pm

Come back Matt Hancock…
It is a world market for trained GPs. The majority of newly trained GPS are international medical graduates (locally with rate over 90%) clearly understand this.
These graduates- and UK trained – will look elsewhere to a better quality of life and finances overseas leaving the UK with the bill but no long term benefit of their GP training.
Poorly thought out announcements raising further uncertainty over their professional autonomy and future will only exacerbate the exodus.

Tim Atkinson 31 January, 2022 7:38 pm

As usual the politician’s answer to the problem is a reorganisation. It doesn’t matter how often you reorganise or restructure, it doesn’t alter the fact that there are too many patients needing to be seen by too few GPs.

David jenkins 1 February, 2022 1:22 am

i stopped doing any work for our local hospital service in 1979, after they refused to pay me for the hours i’d worked. i took them to court. they lost !

since them i have been asked to cover a/e, and the medical unit- i have refused both.

nothing, no power on earth or elsewhere, will change this.

the exceptions are my two consultants, whom i trust implicitly, and for whom i would willingly work for nothing.

however………….they are not running the show. like you and me, they only work in the shop.

so, very sorry, “no extra monee – no extra workee !”

David Jenner 1 February, 2022 8:58 am

Notable that all the letters to the Times on this subject thought it was bonkers and even the NHS confederation said it won’t solve the workforce issue .
Trusts won’t want to take on a service without the funding or the staff .
I think this will melt away but I do think they will try and move the GMS contract to PCN level in the next year or two .

Simon Gilbert 1 February, 2022 9:19 am

“Bye Bye GPs – hello America.”

I’m confused as to why the proposal to move to the logical communist NHS endpoint of all staff being direct employees of the state is anything to do with the (presumably meant by ‘America’) USA!

Turn out The Lights 1 February, 2022 9:54 am

Nothing would incentivise me to work for a big hospital of community trust most have a really bad reputation for abuse and bullying. This has not change and will not change as they see clinicians of all type as cannon fodder .Sounds like a lot of us will be joining agencies to work when and how we want. The whole idea is born out of arrogance in ignorance, they believe their own propaganda than The Top 1% percent cohort of a level passes can be managed by someone who at best was a middle ranking a level student who did a diploma in health service management. Totally doomed to fail and waste an awful lot of money.It will probably finish off any continuity in the system, and collapse it.

Patrufini Duffy 1 February, 2022 10:16 am

“Direct employees of the state” – and so therein lies the conspiracy. What is the “state”? The United States? State of dissolution? State of corporate monitoring? The UK doesn’t even own its major airports, pharmaceuticals nor primary care soon enough.
https://www.nhsforsale.info/private-providers/

Paul Hartley 1 February, 2022 11:14 am

Messing around again. Beware the unintended consequences.

David Banner 1 February, 2022 1:20 pm

“10 practices in Wolverhampton” run by the Trust.
It would be fascinating to have some (anonymous) feedback from those GPs to see if this model really has legs.

Kevlar Cardie 1 February, 2022 1:48 pm

The seat polishers are at it again .

https://www.youtube.com/watch?v=jOt5IZumMDw

Slobber Dog 1 February, 2022 4:23 pm

Can’t see any advantages to this and you wouldn’t even get parity.

Simon Price 2 February, 2022 6:39 pm

GP’s working to a consultant contract, sounds great. Bring it on. Just you might need double the GP’s.

C Ovid 4 February, 2022 1:36 pm

According to the newspaper, the plans aim to reduce hospital admissions by making GPs ‘do more to keep patients out of hospital’.

Just reminds me what secondary care think we are here for. We have our own casemix, you know.