A Government minister has signalled that they will look at whether CCGs should be able to commission primary care services direct from GPs locally in order to promote integrated care.
Health and care minister Norman Lamb said that he was ‘very interested’ in ideas such as CCGs commissioning ‘PMS-style’ contracts with local GPs and that the Government was keen to tackle ‘barriers’ to integration with NHS England.
Speaking at a King’s Fund conference on integrated care yesterday, Mr Lamb said the Department of Health would shortly be publishing a framework to ‘normalise’ integrated care in the NHS, with tools to help commissioners, such as standard contracts and support for ‘pooled budgets’.
Mr Lamb also reiterated the Government position that the recent surge in demand at A&E departments was due to patients not being able to access primary care. He said this was an example where general practice needed to do things ‘differently and better’.
Speaking at the conference, Dr Hugh Reeve, a GP in Grange-over-Sands and clinical chair of Cumbria CCG, asked Mr Lamb whether CCGs would be allowed to ‘get very involved with the commissioning of general practice’.
He said: ‘I would like the NHS England to give us a clear framework in which we can work, then give us the permission to start negotiating new PMS style contracts and perhaps even wider than just a contract with individual practices but to involve community services as well.’
Mr Lamb responded: ‘I am very, very interested in the points that you were making there, and I am not in a position, I don’t have the authority to make any sort of commitments to a particular route but I think it is very interesting.
‘I am keen to talk to Martin [McShane] and his other colleagues at NHS England about these ideas. What I will say is I think we need to be completely open minded and I will return to this next week about how we address barriers to this.
‘Because we need to free up people locally to do great things, and recognise that sometimes nationally we put barriers in the way and getting shot of them.’
NHS England is currently conducting a fundamental review of primary care funding, with ideas about how to revamp the way general practice is incentivised to be put out later this year.
Mr Lamb said there was an appetite amongst GPs to do things differently. He said: ‘There are a lot of GPs who feel that things can be done better than they are at the moment.
‘We have out-of-hours care which too often falls down so people end up with the default option of A&E because there’s nothing else they feel confident about.’
He added: ‘I find it virtually impossible to see a GP. Thankfully my GP is prepared to exchange emails with me and most of the things I need to talk to with my GP I can deal with via email, but to force everybody into the 10-minute slot seems to me a bit daft. By making the use of technology more central you can free up people’s time to concentrate on the real challenges which is what I have been talking about.’
NHS England director for long-term conditions Martin McShane said there was a ‘universal outbreak of acceptance’ that GP funding needed to change.
He said: ‘That is a massive challenge for the whole system, not idiosyncratic or individuals, but we need to do it with GPs, not to GPs, we need to do it with community services, not to community services, we need to do it with social care, not to social care. So we need a new conversation, a new way of working. I think the reforms actually present us with an opportunity, love them or hate them, to do that.’
Mr Lamb also revealed that the Government would publish a major framework to encourage more integrated care next week.
He told the conference: ‘We will publish a framework on normalising integrated care next week. It will include information on how to acquire the tools and the techniques that help spread integrated care. We will share practical tools that can be adapted to fit local circumstances, such as standard contracts, predicted risk models and support for pooled budgets. We are also setting up a national knowledge sharing network so that the most useful lessons can circulate as quickly as possible.’