BMA ‘highly sceptical’ of trusts delivering primary care services in neighbourhoods

The BMA has told the Government it is ‘highly sceptical’ of trusts’ ability to deliver primary care under new neighbourhood contracts.

The union suggested that GP practices are better placed financially than trusts to take on primary care services in neighbourhood contracts. 

It comes after the Government revealed last month that ICBs will be able to commission trusts to hold integrated health organisation (IHO) contracts, as first described in the NHS 10-year health plan.  

The BMA’s argument came in written evidence submitted for the parliamentary Health and Social Care Committee’s inquiry into the role of NHS estates in delivering neighbourhood health services. 

It said: ‘Facilitating NHS trusts to take on primary care services via neighbourhood contracts through the 10-Year Health Plan may severely undermine the value for money currently delivered within primary care and general practice.  

‘NHS trusts are not bound by the same financial constraints as primary care and general practice providers and many are routinely in deficit, while few, if any, have specific experience or insight into the operation of services at the proposed scale’, it argued.  

‘Because of this, the BMA remains highly sceptical of the intent to place NHS trusts in charge of the commissioning and provision of primary care under multi-neighbourhood provider contracts.’ 

The BMA also used the evidence to urge the Government not to build neighbourhood health centres (NHCs) using private finance – a model which will fund eight in 10 newly-built NHCs. 

The Government has confirmed 80% of the 70 newly built NHCs (and around four in 10 of the total) to open by 2030 would be funded through public-private partnerships (PPP) – a form of private finance. 

‘The BMA has significant concerns about the proposed use of private finance to fund the development of new or refitted sites to house Neighbourhood Health Centres (NHCs) due to historic poor value for money and service offered by these arrangements.’ 

‘Regarding the neighbourhood estate specifically, the BMA has also raised notable concerns about the proposed use of private finance to fund the development of new or refitted sites to house NHCs.’ 

Around 130 NHS schemes were funded by the Private Finance Initiative (PFI), another form of private finance, until 2018 and are expected to ultimately cost more than £80bn in repayments, with the model criticised for its inflexibility and perceived value for money.   

‘Instead of these costly and convoluted measures, the BMA strongly believes that direct investment by the Government is the most cost effective, democratic, and responsible means of injecting sorely needed capital funding into the NHS.’ 

The BMA suggested instead that GP practices should have easier access to levies on developers that finance local infrastructure, such as the Community Infrastructure Levy (CIL). 

The BMA has previously criticised what it perceives as the Government placing secondary care in a position to lead on neighbourhood health services.  

NHSE recently announced a scheme which invites hospital trusts to bid for GP practice premises owned by the landlord NHS Property Services (NHSPS) but which excludes GP practices and local authorities.  

The RCGP has also responded to the health select committee enquiry, arguing for the protection of individual GP practices and continuity of care.

Its submission said: ‘Neighbourhood health expansion must be planned so it strengthens, rather than displaces, the role of individual practices, protecting GPs ability to provide continuous care for registered patients, manage risk and long-term complex conditions as specialist generalists, and train the future GP workforce while contributing to neighbourhood health where they add value.’

The RCGP also said that ‘while new centres and refurbishments are welcome, many GP premises are already located within the communities they serve and, with targeted capital investment, could be upgraded to function as NHCs more quickly and at lower cost’.