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Future GP practices should work as family care networks

Call for a radical new GP contract to cope with growing demands

Adrian O'Dowd

Wednesday, 19 February 2014

GP practices will have to work together as ‘family care networks’ to deal with the expected shift of care from hospitals to the community, concludes a report published today by The King’s Fund.

The think tank’s report Commissioning and funding general practice: making the case for family care networks calls for a new GP contract that will require practices to link up with others so they can pool expertise and resources.

The government and NHS experts have often called for a shift in the way care is provided from hospital based settings to one that is more community based so that people receive healthcare closer to home, given the growing needs of an ageing population and rising numbers of people with long-term conditions.

However, the report argues that most GP practices are too small to do this on their own so they need to work together in federations or networks to achieve the necessary scale.

There is a need, therefore, for a “rapid, radical shift” from the current model of general practice to the use of federations and networks of practices able to work on the scale required for effective integration of services.

Such networks would allow GPs to strengthen their role as providers and co-ordinators of care in collaboration with other staff working in the community and some hospital-based specialties.

The report includes case studies from four areas where practices are working in this way, providing additional services beyond those required under their core contract making use of flexibilities such as enhanced services contracts, QOF, and tendering for further local services commissioned by the CCG.

Currently, there are three types of core contract – the General Medical Service (GMS) contract, held by 55% of practices; the Personal Medical Services (PMS) contract, held by 40% of practices; and the Alternative Provider Medical Services (APMS) contract, held by a small number of practices.

In the report, the authors propose a new GP contract to sit alongside existing arrangements, which would fund a defined population (registered list) to be determined by a combination of population need and the range of responsibilities included in it – bringing together funding for general practice with funding for other services.

Such a new contract would require practices to link up with others to work at scale and benefit from pooled expertise and resources.

New arrangements would be focused on the outcomes that providers would be expected to deliver under the contract and not on how they deliver them, offering providers greater freedom to innovate and collaborate.

Chris Ham, chief executive at The King’s Fund and one of the report’s authors, said: “This new funding and commissioning model for primary care could offer GPs an important opportunity to lead the way in finding new and innovative ways of working.

“At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring money into general practice if GPs take responsibility for providing and co-ordinating a wider range of services.”

The BMA was sceptical about introducing a new contract and the chair of its GP committee Dr Chaand Nagpaul said: “General practice does not need another reorganisation on the back of the incredibly time consuming and costly restructuring GPs have only just undergone.

“Instead we should be focusing on tackling the serious workload and financial challenges facing GP practices, and supporting them to evolve and develop rather than wasting resources rearranging the NHS’s already complicated bureaucracy.”

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