Giving hospitals GP contract powers is like asking the fox to guard the henhouse

Editor Sofia Lind on how the Government’s neighbourhood health framework shows how the direction of travel is sidelining general practice in favour of trusts

If you’re a patient – or even a GP – you may by now think the Government wants to put GPs in charge of the new ‘neighbourhood NHS’, as that is what they keep saying.

But for all the rhetoric, the evidence keeps mounting in a different direction. If anything, it looks increasingly like asking the fox to guard the henhouse.

The Government yesterday published its ‘neighbourhood health framework’, setting out more detail on its 10-year NHS reform ambitions. GPs feature prominently, cast as leaders of this new model. But once you get into the detail, it is hard to escape the sense that ministers still see hospitals as the ones who should really be in charge.

Further evidence for this inkling came as trusts have been asked to express an interest in taking over contracts for GP practice premises currently held by NHS Property Services.

It feels like a lazy default. Trusts are large existing structures, with governance already in place and clear lines into Government. So why not just hand them primary care as well?

But that thinking carries obvious risks. I have argued before in this space that the Government is in danger of throwing the baby out with the bathwater. I reiterate – even its own Darzi review noted that general practice is the only part of NHS that can’t run a deficit.

The framework confirms plans for integrated health organisations able to take on delegated commissioning powers for general practice contracts. Wes Streeting has previously said there is ‘no reason‘ GPs could not lead these organisations – but this framework actually puts it in black and white that only hospital trusts will be able to do so. GP organisations cannot, unless they form an alliance with a trust.

When the structures being created from the top consistently favour trusts, and when GP partnerships are explicitly excluded from arrangements such as IHOs and the PropCo contract transfers, it is not hard to see where this is heading. Because ultimately, this is about who controls the money.

And in the NHS, when money is tight – and it always is – it is the acute sector that gets bailed out. That has been the pattern for years. So the idea that giving trusts greater control over general practice funding will result in more investment in general practice runs counter to pretty much all available evidence.

The BMA has urged practices to make written plans setting out how they will take leadership roles in the new neighbourhood structures. Beyond that, though, it has made relatively little noise about what is starting to look like an unstoppable direction of travel. We have been told they will respond when they have something ‘substantial’ to say.

My last editor’s blog was focused on A&G and how hospitals will be put in charge of deciding what a GP referral now is. Since then, NHS England has tried to explain the benefits by saying that allowing consultants to decide whether a patient sees a specialist instead of the GP would ‘reduce bureaucracy’ and not impact a GP’s decision to ‘refer’. But that is beside the point when you completely change what a referral is.

It used to be: patient gets seen by a specialist. Now it is: patient may or may not be seen by a specialist. And it is, crucially, out of the GP’s control. In the neighbourhood framework, the Government specifically says the reworked A&G model ‘will put GPs in control when it’s unclear whether a patient needs specialist care’.

Now this is just gaslighting – which I know Copperfield is writing his own blog about this week…

I would like to think I am wrong, and that the Government really does mean what it says about handing power to general practice. But at this point, the slogan is not matching the plan. And I am not sure many GPs will be convinced otherwise.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn 

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