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GPs to be brought under hospital trusts’ control under plans announced by Labour



Labour has announced plans for every hospital to become an ‘integrated care organisation’ with ‘GPs at the centre’, but GP leaders have warned this could lead to the ‘destruction of practices’.

Speaking at the Labour party conference in Manchester today, shadow health secretary Andy Burnham said he wanted hospitals to grow into the community and ‘into people’s homes’, providing an ‘end-to-end journey’ for patients.

This overhaul of hospital funding would be supported by the £2.5bn funding boost to the NHS.

But GP leaders have said that they are ‘extremely worried’ about the plans, warning they could lead to the ‘destruction of practices’.

The comments come after Mr Burnham revealed – in an interview with Pulse – that he wanted general practice to move towards being a salaried profession, with GPs working as employees of larger integrated care organisations.

He said he will move away from paying hospitals for their activity to funding them through a ‘year-of-care tariff’ that would see them being paid for whole pathways of care for individual patients.

He told delegates: ‘We will ask hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care – physical, mental and social. Why? Because it makes no sense to cut simple support in people’s homes only to spend thousands keeping them in hospital.’

Addressing ‘any family caring for someone with long-term needs’, Mr Burnham said there would be ‘one team’ around them, meaning ‘frail or vulnerable people’ should no longer be ‘shunted around the system’. Instead, he said, ‘this team will come to you’.

He added: ‘You and your carers will have one person to call to get help so no longer [going over] the same story over and over again. You will have a care plan personal to you and your family. If you and your carers get what you really need from the start, then it’s more likely to work.

‘Building the NHS around you will need a new generation of NHS staff, as Ed [Miliband] said yesterday. So we will recruit new teams of home care workers, physios, OTs, nurses, midwives, with GPs at the centre. And we will have mental health nurses and therapists at the heart of this team, no longer the poor relation on the fringes of the system but making parity a reality.’

But he added that Labour’s plans for whole-person care ‘will only work if the finances support what we are trying to do’, adding: ‘It doesn’t work if the finances are still about an episodic tariff, is about treating people in hospitals. The only reason why [Labour’s plan] has a chance is because from that consolidated fund at local level you can create a year-of-care tariff covering all of one person’s needs.

‘That is so important because then the incentive switches from treating people in hospital to supporting people in their home.’

Year-of-care schemes have been touted as the ultimate in ‘integrated care’ and been piloted by the current Government. During the conference, the Labour party has announced that it intends to set out a 10-year plan for Britain, including for how to fully integrated health and social care by joining up CCG budgets, social care budgets and the primary care budget held by NHS England into one single budget controlled by health and wellbeing boards.

However, Dr Richard Vautrey, deputy chair of the GPC, said GPs would be ‘extremely worried’ about the plans.

He said: ‘There are very few people who want yet another major re-organisation, which these plans seem to suggest. We would want to encourage greater co-operation and collaboration between health and social care organisations within an area, working with a common agenda and breaking down barriers between them and practices have a long history of working together and with others.

‘It was not necessary to undermine their contractor status to do this and, in many cases, they worked closely with social and other healthcare providers. This model of working should be built on, not undermined. We want to see community teams, including hospital specialists, built around the practice and this could deliver many of the aspirations articulated by Andy Burnham. However, GPs will be extremely worried about the creation of large organisations employing salaried GPs as this would lead to the destruction of practices, which patients value so highly.’