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GP practices across whole county set for ‘voluntary’ contract under NHS plan



Every practice in Cornwall could be moved onto a new voluntary GP contract by 2020/21, according to plans to overhaul the NHS in the area.

The programme will see six multispecialty community providers (MCPs) look after between 65,000 and 105,000 people each, covering the area’s population of 560,000 patients.

Within the MCPs, 20 groups of practices will operate with registered populations of between 15,000 and 45,000.

According to the document, the ‘clusters’ of practices will offer services that are currently delivered in secondary care, such as mental health services and urgent care.

The plan to integrate care in the community is expected to shave £24m off the area’s expected deficit of £264m by 2020/21.

But GP leaders have said will not happen as the Cornwall and Isles of Scilly LMC has yet to be consulted on the changes.

Dr Beth McCarron, GPC member and representative on the LMC, said setting up an MCP might work for some GPs but ‘one size doesn’t fit all’.

She said: ‘They can’t just put an MCP in place without practices signing up to and agreeing to the change so I think that the STP [sustainability and transformation plan] can say what it likes. Unless it has general practice on board then change is going to be extremely difficult.’

She added that the rural nature of practices in the area, combined with the deficit facing NHS Kernow CCG, would make it difficult to deliver services differently. 

On a wider scale, health and social care leaders in Cornwall are working closely with those in Devon to provide specialist services ‘at a scale which is not sustainable by Cornwall and the Isles of Scilly alone’.

This includes sharing Devon’s emergency departments with patients in the east of Cornwall, ‘continuing to utilise Devon’s emergency services as required’.

The Devon plan to overhaul NHS services adds that ‘integrated local planning will also take account of natural cross boundary flows’.

It says: ‘Most significant is the East Cornwall population served by Plymouth Hospitals NHS Trust. We are working with Kernow CCG to ensure our plans are appropriately aligned.’

A spokesperson for the sustainability and transformation plan said that it was not yet clear when the MCPs will become operational as the proposals are yet to be sent out for consultation.

What are the sustainability and transformation plans proposing?

Pulse’s scrutiny of the 44 STPs have previously revealed how:

  • GPs in one region of England may have to shoulder an increasing burden of patient care  following the merger of two acute care trusts in Nottinghamshire;
  • In Dorset, a plan for the sustainability of the local NHS suggests that a current 98 GP practices, operating at 135 sites, ‘will over-stretch’ local ‘workforce and finances’. It suggests that a ‘reduction in the number of sites’ would lead to a better provision of services ‘for more hours of the day and days of the week’;
  • In Hampshire and Isle of Wight, a reduction in GP workload by almost a third is sought, while also significantly reducing patients’ face-to-face contact with primary care.
  • In North London, practices with list sizes under 10,000 patients could face closure amid moves to create primary care ’hubs’ with lists of 30,000.
  • In East Devon, more than half of community hospital beds could be closed.
  • NHS managers are expecting GPs in one area of England to slash their prescribing costs by a ‘very ambitious’ 15%, while another is targeting 7%.