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Majority of GPs should be employed by trusts, says Javid-backed report


GPs employed trusts contract


The health secretary has welcomed a report that recommends phasing out the GMS contract by 2030, with the majority of GPs contracted by scaled providers such as hospital trusts.

The report by think tank Policy Exchange today also recommended a £6bn ‘rescue package’ for general practice to steadily ‘buy-out the GP owned estate’.

In a foreword to the report, the health secretary said that it ‘offers some credible ideas and insights’.

He added that primary care has an ‘exciting future’ but that the Government needs ‘to think deeply about how services are designed’.

It comes as Pulse revealed yesterday that Government officials have visited Royal Wolverhampton NHS Trust’s salaried GP model to explore ‘alternative ways to deliver primary care’.

The report recommended that there must be ‘a commitment to phase out the GMS contract by the end of the decade’, to be replaced by ‘a series of one-year top-up contracts until its eventual phase-out by the mid-2030s’.

It added that incentives between primary and secondary care should be matched up, and ‘GPs should become predominantly salaried and contracted by scaled providers (trusts, provider collaboratives, or large-scale primary care operators)’.

The report said: ‘This is not a nationalising of general practice: independent provision will continue to play a central role across primary care, but with incentives to work at a greater scale and with reformed approaches to contracting and reimbursement.’

Policy Exchange advised that general practice should move to an ‘at-scale model with specific elements delivered through “layers of scale”’, with workforce planning and lease responsibility at ICS or ‘scaled primary care provider’ level.

In his foreword, Sajid Javid said: ‘There is an exciting future for primary care and we need to think deeply about how services are designed and planned – not just within general practice, but across pharmacy and dentistry too.

‘To provide a 21st-century offer to patients, we must give the front-line innovators the right tools to evolve to meet the needs of patients in the future.’

He added: ‘This Policy Exchange report offers some credible ideas and insights – across digital transformation, workforce, and personalising care provision. I welcome the report as a pragmatic contribution to this vital debate on the future of the NHS.’

Mr Javid added that during his tour of the country, ‘a consistent message [he] heard from the public was the frustration they experience when accessing their GP’. 

The report said GPs have ‘never been more important’, but that ‘the current model is neither adequately staffed, nor optimally planned’.

It also recommended the introduction of ‘real-time, open-access “Trip-Advisor style” patient reviews’ of GP practices.

This comes after the Government and NHS England’s controversial October GP access plan set out that patients will rate GP practices in ‘real time’ via text message, with results to be published this year.

Other policy recommendations made by the report included:

  • Clear guidelines defining ‘demand pressure’ so GPs can report to LMCs ‘against a national baseline’;
  • A support package to keep GP partners in post, alongside offering ‘full employment’ for current partners;
  • NHS England and the Government using technology to address GP shortages in impoverished areas;
  • Looking at ways for NHS-trained GPs to give sessions online from abroad;
  • A strategy between NHS England, the Government, the BMA and RCGP to make general practice an attractive career to medical students;
  • Changes to PCNs in the new five-year framework, with increased ARRS funding;
  • A Government-commissioned ‘review of reimbursement frameworks in primary care’;
  • Digital-first general practice wherever possible, but with more emphasis on ‘service quality’ when commissioning digital healthcare;
  • Improvements to the NHS App and the introduction of ‘first contact primary care navigation programme’;
  • A Digital Health and Care Act in Parliament;
  • ‘Hubs’ to ‘upskill the workforce’ and reduce ‘digital divide’ in communities, commissioned by ICSs.

Responding to the report, RCGP chair Professor Martin Marshall said the College ‘agrees’ that a ‘comprehensive rescue package is urgently needed for general practice’.

However, he added: ‘We would advise caution against implementing wholescale changes to the way GP care and services are delivered and how patients access them, without properly piloting and evaluating such initiatives in terms of efficiency, patient safety and how they impact on the long-standing trusted relationships between family doctors and their patients.

‘We would also urge policymakers to recognise that current models of NHS general practice – including the partnership model – delivers exceptional benefits for the NHS.’

A report from The Times in January that Sajid Javid is planning a review of primary care, which could see GPs incentivised to join up with trusts in a model like that in Wolverhampton.

Under Wolverhampton’s integrated model – known as ‘vertical integration’ – nine GP practices subcontract their GMS contracts to the trust.

READERS' COMMENTS [26]

Azeem Majeed 4 March, 2022 9:02 am

Myself and Simon Hodes did a head to head for the BMJ this week on the question of whether GPs should be employed by the NHS. I give the argument in favour (I appreciate the reality is more nuanced but I have to argue the case I was given).

https://www.bmj.com/content/376/bmj.o406.full?ijkey=keyS4xEQuTPtTBJ&keytype=ref

David Bush 4 March, 2022 9:49 am

Has anyone asked the patients?
Do they want primary care to ‘work at scale’? Or would they actually like to develop a relationship with a GP they can trust?
New models are not always better models – frequently the reverse.

Robert James Andrew Mackenzie Koefman 4 March, 2022 10:14 am

Thanks goodness ill be retired by then, think tank needs to think harder

Alan Woodall 4 March, 2022 10:24 am

Policy Exchange are BOTTOM of the transparency index of U.K. think tanks, it’s basically a bunch of Right-Wing grifters who make Genghis Khan look community-spirited.

Raymond Mcmurray 4 March, 2022 10:57 am

The lobby group that Boris Johnson’s government uses most is Policy Exchange. While it claims to be a neutral educational charity, it was founded in 2002 by the Conservative MPs Francis Maude and Archie Norman, and Nick Boles, who later also became a Tory MP. Its first chairman was Michael Gove.

Simon Ruffle 4 March, 2022 11:09 am

Employ GPs directly and maintain continuity of care. Those words are as ridiculous in the same sentence as Williamson and knighthood.

They’ll offer enough carrot for a wholesale sell out of the profession that means the stick will be used for anyone daft enough for be a community houseman for 40 years after qualifying as a professional.
It ends the profession.

Turn out The Lights 4 March, 2022 11:48 am

If this was the job when I was first thinking of doing medicine I wouldnt be doing medicine now.Pity any poor soul sucked into this quagmire.

Decorum Est 4 March, 2022 12:15 pm

He added that primary care has an ‘exciting future’…….

…too late for me. (Thank God)!

Patrufini Duffy 4 March, 2022 12:58 pm

Bankers.

The majority – who signed up to the PCN. Don’t worry, by 2030 there will be more excrement than even an ICS can handle.

The Prime Minister 4 March, 2022 1:29 pm

JAVID HAS A MINIATURE UNDERSTANDING OF HEALTH…..HE HAS NO RELEVANT BACKGROUND…..I MIGHT AS WELL BE OFFERED A JOB AS A JUMBO CAPTAIN…..
PERSONALLY I AM LOOKING FORWARD TO ALL THIS INSANITY……I FOR ONE WILL STOP ALL THIS SHIT OF GETTING 1 OR 2 WEEKS HOLIDAY PER YEAR AND NEVER GOING OFF EVEN IF ILL…………
FUNNY THING IS IT IS GONNA BE ONE HELL OF A SHOCK WHEN THE GOVERNMENT AND THEIR DAFT FRIENDS AT THE DAILY NUTTER DISCOVER THAT THIS NEW PLAN WILL COST 2-3 X WHAT CURRENT SERVICES USING A GP PARTNER MODEL COST……AND IT WILL BE TOO LATE TO ROLL BACK THE PLANS……..THERE WILL BE THE USUAL “WELL, WITH HINDSIGHT, WE SHOULD HAVE SUPPORTED GP PARTNERSHIPS AND STOPPED ATTACKING GPs…..BUT YOU SEE WE DID NOT KNOW AT THE TIME HOW MUCH THEY DID OR HOW CHEAP THEY WERE”…………….WHAT A BUNCH OF TOTAL FOOLS……….AND GOOD LUCK TO THEM AND THEIR PET ENFORCER THE DAILY B’STARD!!

I AM CHUCKLING ALREADY………….

Reply moderated
Bonglim Bong 4 March, 2022 1:56 pm

I’ve had a look at the NHS Choices reviews of the practices that make up the Wolverhampton model. It is not a pretty site.

Why on earth would you look at 9 failing practices (maybe 8, one is doing okay) and think to yourself:
“That’s what I want every practice to be like”

There are plenty of high high quality practices around. You should look at the factors which make those practices and copy them.

Patrufini Duffy 4 March, 2022 2:08 pm

Yes Bonglim – some of those good practices were small, they liquidated them for the “Working at Scale” model via the Hunt, Prof Field, Prof Madan and Dame Prof Stokes-Lampard era. With a hint of racism. And Yes Prime Minister – it’ll be a great laugh.

Truth Finder 4 March, 2022 2:49 pm

He is a banker. What he want is a big organization so insurance companies can buy them off easily. No thoughts for the patients or doctors.

David Shuttleworth 4 March, 2022 3:21 pm

Excellent idea!
Joined up care, all singing from the same hymn sheet.
Or take your chances in full time private practice, with no guaranteed income..
Xx

Patrufini Duffy 4 March, 2022 4:16 pm

And you Sajid – should be employed by a bank. Not the DoH. Go back to banking. Unless this is your new “investment” portfolio.

Stuart Vas 4 March, 2022 5:06 pm

Think tank Transparify, which is funded by the Open Society Foundations, ranked Policy Exchange as one of the three least transparent think tanks in the UK in relation to funding. Transparify’s report How Transparent are Think Tanks about Who Funds Them 2016? rated them as ‘highly opaque,’ one of ‘a handful of think tanks that refuse to reveal even the identities of their donors.'[29] Website ‘WhoFundsYou?’ rate Policy Exchange as ‘E’, the lowest score out of five for funding transparency

Richa Singh 4 March, 2022 5:33 pm

Great! The only few things which will be missing in exciting future of General Practice- the honest GP goodwill, the extra 100% hours worked by GP Partners
The cost efficiencies and ZERO sickness.

Maybe this is well deserved for abusing hardworking GP

Richa Singh 4 March, 2022 5:41 pm

Besides the journey from PCT to CCG to PCN working at scale has already provided a “lot of excitement and success “ to a degree that the profession is screaming for respite.

I wonder how hard would it be retrain as an Investment Banker ????????

Finola ONeill 4 March, 2022 6:03 pm

“It also recommended the introduction of ‘real-time, open-access “Trip-Advisor style” patient reviews’ of GP practices.”
I’m sorry this was the bit that made me chuckle. It has comedy value.
I think Ditch the PCN DES, heads down and carry on, leave them to burn themselves out with all these cunning plans.
I think in the meantime ditching the PCN DES and leaving them to deal with the shitshow that is “integration”, while laughing from the bylines and not being a part of said shitshow, will amuse me enough till I work out my long term career change should we not get a reprieve from this bunch of twats that is the government and their mouthpiece NHS England; the world biggest quango.

Anonymous 4 March, 2022 8:36 pm

Great stuff
Will work as well as the hospitals do
100,000 gaps in the staffing levels

JOK NI

Not on your nelly 4 March, 2022 8:58 pm

Locum chambers here I come…!

David Banner 5 March, 2022 10:34 am

2030.
So we finally have a date to mark the squalid end of the once proud partnership model.
This slow moving coup started after the 2004 contract temporarily stopped the rot, something successive administrations have never forgiven us for.
OOH ditched, decent pension, income boost via QOF…..how dare GP partners enjoy sociable hours AND a (performance driven) pay rise?
Since then the knives have been out…..the media weaponised against us, pension destroyed, income slashed, and even OOH sneaking back in via the PCN poisoned chalice.
The net result has been an epic recruitment crisis…… older Partners retire early, younger GPs won’t touch partnership with a barge pole, and those in the middle stuck with the work, bills and threat of last man standing bankruptcy.
Thus starved into servile weakness, GP partners will pathetically accept any desultory offer for their buildings and gratefully hand over their contracts to become Trust drones.
And when they only do their contracted work, go off sick with a cold, and take their full leave allowance, someone in 2050 will stare at the grim balance sheets and say “You know what, we should let GPs run their own surgeries in partnerships!”

Richard Greenway 7 March, 2022 12:48 pm

It looks like Mr Javid wants to put his stamp on an NHS reform.
But an error to see GPs as the “problem” nor the solution.

This sounds like a very London centric / urban model -where centralisation care might be possible (but less efficient as disease areas get carved up).

But much of the uk is semi-rural -hospitals may be many miles away and not close enough to provide day to day care or continuity.

For Salaried GP to work -the salary / pay structure needs to be equivalent to Consultants- otherwise why would newly trained doctors go into GP?

Michael Mullineux 7 March, 2022 3:12 pm

Trust me, if this transpires the steady exit stream will become a stampe

Kosta MANIS 9 March, 2022 7:18 pm

Nothing new about this plan. Started when the sheepdogs, aka PCNs, “guided” the majority into the pen with some small bribes and the blessings of a consultant-led BMA (consultants are looking forward to their new SHOs).
I’m watching with curiosity how they’re going to coerce the remaining few.
The beginning of the end for real general practice started in May 2020, but it is sad to see that medical journalists and most GPs are in denial.

Aman Samaei 10 March, 2022 2:01 pm

ha ha
it means , more sick leave, annual leave, study leaves etc.
above all , more Gps migration to out of the UK.