GPs advised not to take part in neighbourhood programmes yet amid ‘lack of clarity’

Exclusive GP leaders in one area have 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.

Earlier this month, the Government announced the first phase of the rollout of neighbourhood health programmes following the 10-year plan, with 42 areas to be chosen to pioneer the new model from September.

NHS England asked ICBs to submit applications to take part, by outlining examples of ‘joined-up working and innovation’ in their areas, including working with GPs, other local health and care providers and voluntary groups.

Applications should be submitted by 8 August but North and South Staffordshire LMCs have told Pulse they have advised their practices to wait to take part in the pilot ‘until they have complete confidence’ that their GMS contracts will be protected.

It comes after GP leaders and experts have raised concerns that the 10-year plan could threaten the independent contractor model, introducing new contracts for neighbourhood services which ICBs can award to different providers, including NHS trusts.

North Staffordshire LMC chair Dr Chandra Kanneganti told Pulse: ‘We advised local GPs not to apply for it – until we have complete confidence that our GMS contracts will be protected.’

South Staffordshire LMC chair Dr Manu Agrawal said that currently ‘there is no clarity’ around the programmes and that practices ‘do not know what they are signing up to’.

He told Pulse: ‘There’s no clarity about where there resources are going to come from and which direction we are travelling.

‘So what we asked practices to do is hold off before they fill out the paperwork, get more clarity. And once we have more clarity, they can make an informed decision on whether to sign up for this model or not.

‘The whole profession is worried about the risks this could bring for GMS and the independent contractor model, so I think there needs to be more clarity.’

In an email to the LMCs last week, seen by Pulse, Staffordshire and Stoke-on-Trent ICB’s associate director of primary care Tracey Cox said that ‘GMS will remain in place’ but that NHS England are ‘still working through the contractual form of the neighbourhood contract’.

The BMA’s GP Committee advised practices that they ‘may come under significant pressure’ from ICBs and other providers to participate in the programmes, but that these are not mandatory.

It warned that NHS England are ‘pushing’ the initial programme at a pace which many practices ‘will not be comfortable’ with, especially ‘given the lack of detail on longer-term funding and contractual arrangements in the plan’.

In new guidance, the GPC said: ‘As such, practices will need to consider the risks and opportunities that the programme may present.

‘Should local general practices not intend to submit an application, we encourage the local profession of a need to be aware of the potential impact of the programme for themselves and their local area, considering the short, medium, and longer term.

‘We would recommend seeking alignment between practices, PCN CDs, the LMC and any local GP federation.

‘Map out the pros and cons and consider how practices may negotiate and “lock-in” external agreements to safeguard the future sustainability of individual general practices within any new or emerging landscape.’

It added that if ‘left unchecked’, the 10-year plan’s proposed structural and contractual changes could begin ‘a move toward salaried or integrated provider models’.

‘This may challenge or undermine the traditional independent contractor model, and, for GP partners, it could mean losing autonomy over practice finances and governance,’ it warned.

However, the GPC said that there must be local GP contractor voices in the decision-making processes around the programmes.

It added: ‘GP practices have a crucial opportunity to lead the design of neighbourhood teams and care models focused on continuity, prevention, and personalised care.

‘General practice can cement its place as a strategic partner in developing and delivering neighbourhood models, rather than as simply a delivery arm.’

NHS England said that chosen areas will be notified on 5 September and they will start implementing the programmes on 8 September.

The first phase of the programme will focus on developing neighbourhood health programmes for ‘adults with multiple long-term conditions and rising risk’.

Pulse has contacted NHS England and Staffordshire and Stoke-on-Trent ICB for comment.