Widespread implementation of a model where hospital trusts manage GP services will not fix the problems faced in the sector, recent analysis by a leading health think tank said.
The report, published last week by the Health Foundation, suggested there is a growing tendency among politicians to propose such primary care reform, and cited trusts where this type of integration is already happening, such as the Royal Wolverhampton.
Authors Judith Smith, Manni Sidhu and Hugh Alderwick suggest this newer model of integration will not address the main issue facing general practice – that the supply of GPs does not meet the current demand for care.
They found there is limited evidence to show that integration of general practice with hospitals has a positive impact, and they suggested GPs ‘are in need of hope and support – not threats of radical changes in how they are organised’.
The report discusses ‘vertical integration’, defined as a model where acute hospital trusts manage general practices and take on employment of GPs, which Pulse analysed last year.
The Royal Wolverhampton, which manages eight directly integrated general practices, is an oft cited example, particularly as it was visited by Department of Health and Social Care officials last year to explore new ways of delivering primary care.
According to the Health Foundation’s analysis, research into the effects of the model on patient experience and outcomes is lacking, but there is some evidence of better coordination between services and more training and development opportunities for GPs.
However, the authors believe it is not yet clear how moving to another organisational structure for primary care would fix its problems.
They wrote: ‘Evidence from the long line of NHS reorganisations shows it would likely cause distraction, additional costs and unintended consequences, along with further loss of GPs, practice nurses and other staff – something that can be ill afforded.’
There is currently no formal movement towards a national mandate for this type of integration, however former health secretary Sajid Javid suggested support for it last year, and the shadow health secretary Wes Streeting recently hinted at movement to a fully salaried service.
Two GP practices in Swindon that were handed to a hospital trust more than three years ago are moving back to independent GP ownership, it was revealed last month.
