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Struggling GP partners set to go salaried as trusts seize practice contracts



Exclusive Around a dozen further GP practices struggling with recruitment woes and defunding are in talks to give up their contracts and become employed by trusts, Pulse can reveal.

NHS England’s Somerset pilot for new hospital-led GP models could soon hold as many as 10 GP practice contracts, and employ all of the partners who are not retiring.

This includes three practices – with a combined 14,000 patients – that gave up their contracts earlier this month (8 April) as well as a further ‘six or seven’ that are in talks.

Meanwhile, in Yorkshire, a foundation trust has taken over a GP practice in response to a workforce crisis and the local PMS review, which saw the practice’s year-on-year funding cut.

It comes as a whole town of GPs in Hampshire are in talks to give up their contracts to the local Multispecialty Community Provider (MCP) vanguard, as previously revealed by Pulse.

Dr Berge Balian, GP lead for the ‘Symphony’ Primary and Acute Care Systems (PACS) vanguard in south Somerset, said the partners owning the 10 GP practices were opting to give up their contracts for a variety of reasons, but that difficulties recruiting and keeping practices financially viable were key driving factors.

The vanguard project, which includes the Yeovil District Hospital NHS Foundation Trust at the centre, has set up a holding company called Symphony Healthcare Services (SHS), which is owned by another group of ‘nominee GPs’ already working for the project. Through this, the PACS can continue running the GP practices under their existing GMS and PMS contracts, Dr Balian said.

He said the first three practices – Ilchester, Yeovil Health Centre and Buttercross surgeries – represented one case of the partners retiring and handing on their contract while the other two were run by a GP-held company that wanted to ‘offload’ the surgeries because they were ‘finding it a struggle to get a stable workforce in those practices and felt it wasn’t worth their while to continue’.

For the remaining six to seven practices where the partners are in talks to become employed by the trust, Dr Balian said it was a ‘strategic’ decision.

He said: ’I think for the second wave of practices, it is because they feel that the direction of travel of general practice is away from small partnerships.

’They think that, strategically, with the whole politics of what has happened in the last few years – with reduced funding to primary care, more emphasis on all the additional services that people need to provide and all the regulation that has come in – it has become increasingly difficult to operate even in a five- or six-partner practice.

’They see this model as being potentially the future.’

But he said the parties are in talks to keep a ‘reversibility clause’ that ’would allow those GPs to take back their GMS or PMS contract under specific circumstances in the future, [such as] if SHS were to fail or to be liquidated, or potentially if there is a proposal to sell it to a private organisation’.

At the same time, in East Yorkshire, the Market Weighton Group practice, a sizeable village practice with a list of 9,500 patients, was taken over by the NHS Humber Foundation Trust on 1 April.

A trust spokeswoman told Pulse that the Market Weighton practice partners had approached the trust directly about taking over their PMS contract. The practice said that the move would allow for ‘resources to be utilised effectively… and create a sustainable working model for staff and patients’.

As part of the transfer, three partners at the practice have become salaried to the trust. Although not yet a PACS, the parties said the takeover would lead to better integration between primary and secondary care services in line with NHS England recommendations.

It comes as in March, a mental health trust and a GP provider company in Sheffield agreed to jointly run five GP practices as the result of winning an APMS contract bid.

Primary Care Sheffield bid jointly with the Sheffield Health and Social Care NHS Foundation Trust, winning two contracts that cover 21,500 patients in the city.

What are PACS?

Like the new GP-led Multispecialty Community Provider (MCP) models, Primary and Acute Care Systems (PACS) aim to integrate general practice with secondary care services, but the difference is that PACS are run by acute trusts.

First described in the NHS Five Year Forward View back in 2014, NHS England indicated PACS would only be allowed in certain circumstances, such as in areas where general practice is ‘under strain’ – but arguably that now covers general practice in most parts of the country.

Already a month after NHS England’s high-level planning document was unveiled, management consultants were circling, with PwC reporting an ‘extraordinary level of interest’ among trusts running GP practices.

But GP leaders warned that a landgrab by hospital trusts would hold risks for GPs as it would allow trusts to ‘take over the world’.