Hospitals could take on contracts where GPs ‘are not stepping up’, says NHSE lead
Hospital trusts will be invited to take on new contracts for neighbourhood services where GPs ‘are not stepping up’, NHS England’s primary care director has said.
Dr Amanda Doyle was speaking at an NHS England webinar on the 10-year plan last night, where she answered questions from GPs about the two new contracts which will be introduced by the Government next year.
The contracts are aimed at enabling GPs to work across larger geographies, delivering enhanced services for people with similar needs across a defined area, or focusing on services that require coordination across multiple neighbourhoods (see box).
ICBs will also be given powers to contract a wider range of providers – including NHS trusts – for neighbourhood health services.
GPs attending the webinar raised concerns that these contracts will be ‘taken up by acute or community trusts’, and Dr Doyle clarified that ‘it’s possible for that to happen where primary care is not stepping up’.
It comes after health secretary Wes Streeting argued that as part of a radical reform of the NHS, acute trusts should be able to provide primary care services and that ‘successful GPs’ should be ‘able to run local hospitals’.
Dr Doyle said: ‘There’s nothing in this plan about getting acute trusts or community trusts to come in and take over primary care provision.
‘It’s possible for that to happen where local primary care isn’t stepping up and able to, but it’s not designed in that way, and so it’s really important that people start to think about what the opportunities are, think about how things could be effectively, better delivered out of hospital in the place they work.’
And answering a question about the future of the partnership model in light of these new contracts, Dr Doyle said that GP partnership ‘may look different’ in the future but there is ‘no intention’ to replace it.
The plan stated that where the traditional GP partnership model is ‘working well’ it should continue, but the two new contracts will also ‘create an alternative for GPs’.
Dr Doyle said: ‘That is really explicit in the plan, there is no intention as part of this to replace the partnership model. There’s no aim to encourage or incentivise people to move away from a partnership model.
‘Some of those partnerships may be bigger or may look slightly different, but we are not looking to move away to a sort of a not-independent contractor model, because of all the benefits we get from it.’
She also acknowledged concerns about GP unemployment, but added that the 10-year plan represents ‘an opportunity to provide significantly increase employment for GPs’.
Dr Doyle told GPs: ‘I am conscious there are concerns about GP employment, but this is an opportunity to provide significantly increased employment for GPs.
‘And don’t forget, since about August 2023 we’ve seen a steady climb in the number of GPs in the workforce, even without the additional roles GPs, and headcount for that’s up to about 1,900 now. So that’s been really successful at getting people into jobs, and we’re keeping going with that.’
Dr Doyle clarified that PCNs will continue to exist as part of the plan, and there is currently ‘no risk’ to additional roles (ARRS) funding.
She said: ‘I think we are building on [PCNs] rather than replacing them. If either a local area or neighbourhood has a series of individual practices on GMS contracts, then we will still need PCNs working at that level in the way they do now.
‘If we have single practice PCNs, then there will be an option for people to roll the two contracts into one effectively.
‘But we are not looking to do anything other than expand the range of things that are delivered at neighbourhood level.
‘There’s no risk to the sort of funding for additional roles or the ability to deliver on a PCN footprint in this.’
She told GPs that conversations with the BMA about the new wholesale GMS contract have started, and that there will be a focus on moving funding from secondary to primary care.
The 10-year plan promised to ‘shift the pattern of health spending’ with ‘greater investment’ into out-of-hospital care, adding that over the next decade the share of expenditure on hospital care will fall.
Dr Doyle said: ‘There is no suggestion that we can suddenly shift all this work and increase all the capacity out of hospital without funding to make it happen.
‘We have already started talking to the GPC about what they would like to see in a fundamentally reformed contract. And we need to start working, particularly on a neighbourhood level contract – what does that look like, and how might we get that into the next round of contract discussions.
The plan ‘absolutely depends’ upon being able to shift funding out of hospital and into primary care to deliver it, she added.
‘We’re looking at what are the financial mechanisms and contract mechanisms, not just for GPs and community services, but particularly for the way in which we pay hospitals, which will enable the money to flow out with the activity,’ Dr Doyle said.
Read all of Pulse’s coverage of the 10-year plan here.
The two new GP contracts
1) ‘single neighbourhood providers’
They will deliver enhanced services for groups with similar needs over a single neighbourhood (c.50,000 people). In many areas, the existing primary care network (PCN) footprint is ‘well set up as a springboard for this type of working’.
2) ‘multi-neighbourhood providers’
Serving 250,000 people, these larger providers will deliver care that requires working across several different neighbourhoods (e.g. end of life care).
They will work across all GP practices and smaller neighbourhood providers in their area.
They will support ‘sustainability and professional autonomy’ by delivering a shared back-office function, overseeing digital and estate strategy, and by ‘providing data analytics and a quality improvement function’.
They will be large enough to create new commercial partnerships, including clinical trials.
They will actively support and coach individual practices who struggle with either performance or finances – including by stepping in and taking over when needed.
Source: NHS 10-year plan
READERS' COMMENTS [6]
Please note, only GPs are permitted to add comments to articles
loads of unemployed GPs eagerly lining up to board the gravy train… just as soon as they find the platform hidden behind layers of red tape
Failing hospitals acquiring struggling practices, what could possibly go wrong.
Hopefully there will be 13 PA jobs consisting of 2 patient facing sessions and a whole lot of “admin time”, like in our local centres of excellence
Patients say in every study they want the “family doctor” who knows them and their families and to see the same doctor. Every government of every colour nods and seems to do absolutely the opposite. It defies belief. Our european neighbours have very local GP services and very much family practice and their health systems time and again have better outcomes that ours.
This isn’t about patient care though, it’s about power and control. Government loathes the partnership as it’s difficult to micromanage and boss us about. They want to tell us what to do in every way. They’ll drop the earnings massively. Mark my words, Doyle will ensure the full time GP will be earning less that a GP registrar.
I assume that when she says “not stepping up” she means not doing stuff for free (eg ear syringing).
So glad i am retiring before this sh*t begins to hit the fan.
Why is she pulling a face t like the pantomime villain.
The simple language translation of this is:
we will create contracts complex enough that they are not workable or suitable for a GP practice with unliited liability.
Then blame those practices for not stepping up when a hospital trust takes over.