Plans for trusts to take on neighbourhood contracts ‘risk bankruptcy for GPs’, BMA warns

Government plans for trusts to take on neighbourhood contracts could ‘risk bankruptcy for GPs’, and appear to undermine the Government’s commitment to the family doctor ‘as we know it’, the BMA has warned.

The doctors’ union published an analysis of the NHS 10-year plan ahead of a special meeting next month to discuss the impact of the proposed reforms.

The document said the proposal for trusts – and potentially other providers – to take on neighbourhood contracts is ‘a major point of apprehension for GPs’ and could risk bankruptcy for GPs if they were to lose services outside GMS.

Following the plan’s publication last month, GPs and experts told Pulse that the proposals could mean that funding will mostly be channelled into large-scale providers and that traditional practices will be left with fewer resources.

It remains unclear whether the new neighbourhood contracts will sit alongside GMS/PMS contracts or in their stead, and who will be responsible for negotiating them.

However, 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 BMA said: ‘The plans for at-scale providers appear to contradict the UK Government’s stated ambition to “bring back the family doctor”, with a risk that acute trusts, rather than practices, will take these on due to their scale and scope.

‘Whilst PCNs or GP federations may be one option for practices to effectively manage the proposed
contracts, many are not incorporated bodies and so the financial and contractual details of any such arrangement may be complicated.

‘If NHS trusts were to manage GP practices within a given area it would undermine the partnership model, the independence of GPs and their decision making, and also lose the significant value for money and proven financial management currently provided by GP practices.

‘It could also risk bankruptcy for GPs if they were to lose services outside the GMS scope (e.g. LES or DES).’

The union added that it is ‘essential’ that GP practices are ‘not pressured to commit to operating under either neighbourhood provider model’, particularly given the ‘serious lack of clarity’ about how these models will operate and what their contractual terms will be.

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

The BMA said: ‘While the plan does not explicitly state this, it is also crucial that those contractual terms rule out the possibility of NHS trusts holding patient lists in place of GP practices, as this would be the end of the current model of general practice.

‘The BMA’s view is that neighbourhood teams should be based around existing GP practices, reinforcing existing relationships between practices and their communities, and should not divert resources, whether staff or finances, from existing provision.’

The document also said that proposals included in the plan to use AI to transcribe patient consultations pose ‘risks associated with patient safety and governance’.

It recommended that general practice should carry out ‘comprehensive data protection and clinical safety checks’ before using new technologies.

It added: ‘Additionally, GPs need protection from NHS Resolution indemnity if the Government’s policy leads to data breaches. Finally, it is crucial that GPs are not liable for any mistakes made by AI introduced into general practice.’

The BMA also reiterated that advice and guidance (A&G) has a role within patient care pathways, but it cannot be used as a replacement for referral to a specialist where the GP ‘deems it clinically necessary’.

The plan announced that A&G will be expanded to more specialties, with a focus in the next few years on new technology developments for ophthalmology, cardiology, respiratory medicine and mental health.

And earlier this month, new data showed that A&G requests have risen by 11% since the Government made a payment available for practices in April. 

‘The impact of the newly introduced A&G enhanced service must be assessed in any subsequent expansion, including whether the level of funding currently provided is adequate to meet the requirements of the service,’ the union added.

The BMA council has called a special representative meeting to ‘debate the risk of the 10-Year Health Plan to the medical profession at large’, and the delivery of safe and effective care to patients, which will be held virtually on 14 September.

Pulse has contacted NHS England for comment.

A Department of Health and Social Care spokesperson said: ‘GPs are at the centre of our 10 Year Health Plan but we can only realise the benefits for general practice by working together.

‘We’ve already recruited 2,000 extra GPs in a year and secured a record funding boost for practices, and we’re committed to working constructively with GPs on contract reform.

‘Neighbourhood Health Services will bring NHS care closer to home and provide better support for people with complex conditions.

We want to see GPs taking on the new single neighbourhood provider contracts, leading multi-disciplinary teams. They’re the best people to do this, with experience thinking about people holistically, beyond a medicalised model of care.’

Health secretary Wes Streeting has previously 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’.

However, following the publication of the plan, NHS England’s primary care director had said that hospital trusts will be invited to take on new contracts for neighbourhood services where GPs ‘are not stepping up’.

And the RCGP recently opposed plans for acute and community trusts to run general practice.

Read all of Pulse’s coverage of the 10-year plan here.