Other NHS organisations take on GP budgets under ‘year of care’ plans

GP leaders have warned that Government plans to introduce ‘year of care payments’ – which could see other NHS organisations take on budgets for general practice services – can ‘only mean the end for the GMS contract’.

The NHS 10-year plan pledged to introduce ‘a capitated budget for a patient’s care over a year’, which will include all primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions – all consolidated in a single ‘year of care payment’ (YCP).

It said that these payments will be ‘an important feature’ of the neighbourhood provider contracts described in the plan, which ICBs will be able to award to different providers, including NHS trusts.

‘Operating at a larger scale, integrated health organisations will take on budgets for the entire population being served,’ the plan added.

The YCPs are designed provide ‘a sharp incentive’ to keep patients out of hospital because local NHS organisations will benefit from ‘reducing emergency visits and reinvesting in community services’.

But GP leaders have told Pulse that these one-year budgets would blur the line between funding for primary and secondary care, and that this model could create tensions should NHS trusts be in charge of the money.

It comes after one large ICB has already chosen a number of hospital trusts to oversee the new ‘neighbourhood health service’ across its footprint, announcing that the trusts will also hold the funding.

The 10-year plan said: ‘To support the shift of care away from hospital settings towards neighbourhood care, we will develop year of care payments (YCPs), through test and learn approaches.

‘These allocate a capitated budget for a patient’s care over a year, instead of paying a fee for a service. This new payment mechanism will be calculated according to the health needs of the population being served and will allow providers to invest in high-quality, proactive and planned care for patients.’

From the next financial year, the Government will begin work with a small number of ‘pioneer’ systems who are already ‘further advanced in designing their new care model’ to implement ‘notional’ YCPs, according to the plan.

It added: ‘We will test, refine and roll out these new payment models, focusing on approaches that reward same-day and out-of-hospital care. This includes support for services such as same day emergency care, virtual wards, and urgent community response.’

According to Berkshire, Buckinghamshire and Oxfordshire LMCs, this model suggests that budgets between primary and secondary care ‘will be indistinguishably merged’, and also any previous funding specific to GP ‘will be more broadly simply labelled “primary care”’.

‘This payment structure is incompatible with the current GMS core funding process and therefore can only mean the end of GMS,’ the LMC said in a message to GPs.

Professor Azeem Majeed, head of the department of primary care and public health at Imperial College London, told Pulse that the YCP model may create tensions between primary and secondary care.

He said: ‘My prediction is that foundation trusts will want to retain the YCP funds for their own services and will be reluctant to transfer any additional funding to general practices other than that required for the national GMS GP contract.

‘I also think it was a mistake for the 10 Year Health Plan not to discuss the idea of Primary Care Networks (PCNs) holding the YCP budgets.

‘This would have created a similar model to the “total fundholding” system we had in the past and given general practices considerably more power to influence NHS trusts.’

Doctors’ Association UK GP spokesperson Dr Steve Taylor said that trusting secondary care with any element of primary care budgets is ‘a recipe for disaster’.

He said: ‘GPs have experienced fixed budgets for patients for decades and have been unable to claim more or run at deficits. Secondary care has run deficits and often been bailed out; trusting secondary care with any element of primary care budgets is a recipe for disaster.

‘Patient funding for primary care and GP services needs to be higher and never lumped in with secondary care costs.’

Katie Collin, partner at specialist medical accountancy firm Ramsay Brown, warned that these one-year budgets would ‘blur the line between’ funding for primary and secondary care, adding in more layers to ‘an already knotty funding system’.

She told Pulse: ‘This year’s GMS win provided, for once, some funding clarity and stability. But “year of care payments” call the whole contract into question and leave partners with yet more uncertainty on how they will receive funding. 

‘Not only that, but it could even end up diverting funding out of primary care and heap more pressure onto secondary care providers. It’s one step forward, three steps back.

‘We’re amid a primary care push, and I understand that the Government wants to make changes that will set practices up for success. But complicating funding structures further simply isn’t the answer. If anything, plans like these indicate a fundamental misunderstanding of the needs of primary care providers.’

Pulse has contacted the Department of Health and Social Care asking for more details on how the payments are going to work, and to clarify if they are going to replace funding provided via GMS in some areas.

NHS England told Pulse it could not share any further details about the YCPs.

Earlier this week, Pulse revealed that GP leaders in one area advised practices to hold off from taking part in new ‘neighbourhood health programmes’, amid a lack of clarity and fears that these could jeopardise GMS contracts.