Devolution: Manchester reforms can benefit patients but GPs need support to adapt

Greater Manchester's plans to use devolved powers to integrate health and social care could bring huge benefits for patients, says BMA deputy chairman and Manchester GP Dr Kailash Chand. But the reforms won't be easy, he warns, and providers including GPs will need time and support to adapt.

At the end of 2015, the report Taking charge of health and social care in Greater Manchester was published in preparation for the region taking full responsibility for its devolved £6bn health and social care budget from 1 April.

Both the challenge and the opportunity are significant over the next five years. If  the project doesn’t use the £6bn devolved budget in a radically different way around our health and social care system, it will be facing a major deficit of £2bn by 2021 - a recipe for another NHS reorganisation failure.

The blueprint to implement integrated care involves the creation of local care organisations that would see GPs, hospital doctors, nurses and other health professionals come together with social care teams, the voluntary sector and managers to plan and deliver care.

Primary care role

The idea is that when people do need support from public services it will be mainly in their community, with hospitals only needed for specialist care. GPs are very much aware of the key role primary care has at the heart of these developments, keeping people well and out of hospital as much as possible.

There is plenty of evidence to suggest that thousands of people are treated in hospital, when their needs could be met in the community.

Manchester devolution is looking into potential contractual arrangements with GPs, the interface between general practice and colleagues in primary care, the role of prevention and self-care and the role new care models may play in the primary care environment in Greater Manchester.

The success of the project would be in recognising a robust case for the value of general practice, including GPs' preference for retaining a national core contract and that considerable reassurances will be required for any GPs considering new contractual arrangements.

Grassroots general practice

It is essential that the voice of grassroots general practice is heard loud and clear. While a formal representative structure for GPs is helpfully being established in Greater Manchester, the real test will be how effectively the discussions and decisions of that group are informed by the views on the ground – a point I will continue to stress in all our conversations with decision-makers, both locally and nationally.

Leading figures behind the devolution plans have called Greater Manchester 'the sick man of England', pointing to the population suffering higher rates of illness and lower life expectancy than it should.

I agree with those who have called this a 'unique opportunity to bring together health and social care', building from a new model of primary care

But, to achieve this, providers and local systems will also need honesty and realism from Greater Manchester’s political leaders about how much extra the NHS can take on and when, given the budget constraints; how long such major transformation actually takes and the political support it needs. 

Devo Manc holds out the promise of meaningful and deep integration within the health service, and between health and social care. This integration has great potential to offer real benefits to patients.

In particular, it could help to deliver genuinely patient-centered and genuinely co-ordinated care. That would be quite a prize for patients in Greater Manchester. But the evidence tells us that delivering this will be tough. Very tough. Complex integration takes time and patience to deliver results. And given the efficiency demands being placed on the health system currently, we might say time is short.

GPs, providers and local systems will need an unprecedented level of space and support to create and deliver Manchester devolution aspirations, and will need to structure and resource themselves differently and behave very differently if they are to succeed.

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