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NHS England set to pay GP practices to combine to cover 30-50k patients

GP practices in England will see initial funding to come together in super practices or federations with 30,000-50,000 patients, under plans announced today by NHS England.

By around 2019, NHS England expects ‘100%’ of GP practices – including in rural areas – to have formed collaborative ‘local care networks’, covering these large cohorts of patients.

NHS England said this comes as early data showed these new care models, which includes multispecialty community providers (MCPs) and primary and acute care systems (PACS), were effective in reducing growth in emergency hospital admissions.

Its report Next Steps on the NHS Five Year Forward View said said this large model ‘allows practices to share community nursing, mental health, and clinical pharmacy teams, expand diagnostic facilities, and pool responsibility for urgent care and extended access’ and can work more closely with community pharmacists.

It added that this ‘can be as relevant for practices in rural areas as in towns or cities’ because ‘the model does not require practice mergers or closures and does not necessarily depend on physical co-location of services’.

It listed ‘various routes to achieving this’ including ‘federations, “super-surgeries”, primary care homes, and [MCPs]’, adding that: ‘Nationally we will also use funding incentives – including for extra staff and premises investments – to support this process.’

The strategy is in line with health minister David Mowat’s recent comment that GP federations or practices would reduce to 1,500 across England.

NHS England said this comes as ‘both PACS and MCP vanguards have seen lower growth in emergency hospital admissions and emergency inpatient bed days than the rest of England’.

With the caveat not to ‘over-interpret’ currently available data ‘given sample sizes and duration’, it said that when comparing the two most recent 12-month periods for which data is available (until December 2016) the emergency admissions growth rates were 1.1% for PACS vanguards and 1.9% for MCP vanguards, compared to ‘the non-vanguard rest of England’ at 3.2%.

Speaking to Pulse, NHS England’s primary care director Dr Arvind Madan said practices which were successful in achieving savings by reducing admissions could also expect to see this reinvested in their businesses (see box).

The Five Year Forward View update further said that aims to reduce hospital pressure will also form the basis of the QOF replacement that NHS England is discussing with the GPC.

It said NHS England will ‘seek to develop and agree with relevant stakeholders a successor to QOF, which would allow the reinvestment of £700m a year into improved patient access, professionally-led quality improvement, greater population health management, and patients’ supported self-management, to reduce avoidable demand in secondary care’.

NHS England said its plan will also see all of the 44 sustainability and transformation plan (STP) areas eventually move to ‘accountable care systems’, which will be awarded for reducing admissions and boost population health.

But health think-tank the Nuffield Trust questioned whether the plans would be successful, especially in light of the news that GP workforce numbers are not improving.

Its chief executive Nigel Edwards said: ‘Perhaps the biggest stumbling block facing these plans is the make-up of the NHS workforce.

‘The plan rightly sets out an aim to do more outside hospital. Yet we have fewer district nurses than ever before, and although plans to increase GP numbers are very welcome, they come after a long history of underinvestment and missed recruitment targets. The latest figures show numbers fell by 400 last year.’

And BMA chair Dr Mark Porter said: ‘This plan contains many good measures but does not address the fundamental funding pressures undermining the delivery of health and social care. The efficiency targets set in this plan are fanciful, given that most hospitals have been pushed into the red.

‘The constant calls for more GPs to be available for longer is not matched by the reality on the ground – far from delivering 5,000 extra GPs promised by the government, figures from earlier this week show that the number of fulltime GPs is, in fact, falling.’

GP practices will benefit from reducing hospital pressures, says NHS England

Dr Madan said that GPs who were able to ‘change clinical behaviour would see money ‘invested back into their own infrastructure collectively’.

He said: ‘Imagine a new world of networks for general practice. The new architecture for how we deliver across neighbourhoods, with some funding to get them going, and some ability to take a share of evidence based savings they make across prescribing, elective, and urgent care in their patch.’

He added that these ‘local care networks of 30,000-50,00’0 would cover 50% of the country ‘by the end of next year’, and ‘100% by the year after’.

According to Dr Madan, these networks would be used as the ‘vehicle’ for making GP Forward View iniatives including collective training, employing multidisciplinary teams and delivering seven-day access.

Dr Madan stressed that this was not a return to fund holding as ‘this money will not land in GPs’ back pockets’ but would be reinvested into developing the network and staff teams.

‘This is architecture that everybody can get involved with’ he told Pulse ‘and it gives them some skin in the game in ways of changing clinical behaviours, in an evidence based way, that can be invested back into their own infrastructure collectively,’ he said.


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