BMA guidance for LMCs warns GPs to consider the effects on contracts and funding of moves to create new integrated provider organisations being developed by the NHS in response to the Five Year Forward View.
The document calls on LMCs to ask a series of questions of any local plans to develop new care models.
Local GP leaders should ask whether GP expenditure will be ring-fenced or protected or whether it will be fully merged with other health and care services, the guidance says.
New models of care
It also warned that new provider organisations may be considered part of the independent sector, rather than NHS organisations, and so not obliged to implement nationally-negotiated employment contract changes.
The guidance calls on GPs to consider their contractual position in the new organisations, whether they will be employees, shareholders or subcontracted independent practitioners, whether GPs will remain on current GMS/PMS contracts or move to new contract types, and whether there will be a contractual right to return.
The guidance warned that contracts developed for new care model organisations were likely to be local, time-limited APMS contracts.
GP leaders said it was becoming ‘increasingly clear’ that the direction of travel in all new care models which redefine the relationship between primary and secondary care was towards organisations providing or procuring a range of primary, community, secondary and social care services; outcomes based contracts; and new commissioning structures including joint commissioning and split commissioning.
Core GP services
‘There is little certainty anywhere about how exactly these reforms will take shape. One of the main areas of uncertainty at the moment is how contracts for core general practice services will fit into the new models and, indeed, whether it will be possible for GPs to maintain a ring-fenced budget for core work,' the guidance warned.
‘NHS England is working to develop a model contract for MCPs but it is likely that this will be quite basic and that local areas will retain considerable freedom to design contracts and services.
‘All of these developments have potentially far-reaching implications for GP contracting and service delivery. In some cases, the role of LMCs in safeguarding GP interests will never have been more challenging or more critical.’
GP leaders recently warned GPs considering moving to new voluntary contracts - being developed to support MCPs delivering care for populations of 30,000 to 50,000 patients - that the move could be a one-way street. Practices could find it too difficult to switch back to their previous contracts even if there is a technical right to return.
GPC deputy chairman Dr Richard Vautrey told GPonline there were ‘huge risks’ for practices choosing to relinquish their GMS or PMS contract to sign up for an overarching MCP deal.
‘Practices really need to enter into these types of arrangements with great caution and realise that it could be a one-way street. The promise of a return ticket to their current status could well be illusory,’ he said.
‘The risk is once you’ve started to disaggregate that and move away, it’s very difficult to move back to a practice-based funding arrangement.'