NHS Future Forum calls for GP contract to integrate practices

The GMS contract should be overhauled to incentivise greater integration between GP practices, the NHS Future Forum has recommended.

In its second report on the future of the NHS, the forum said health professionals should make 'every contact count' and promote healthy lifestyle choices in every consultation.

Longer GP training should be looked at 'as a matter of urgency' and the government must develop a new generation of patient reported outcome measures (PROMs) to evaluate patients' experience of healthcare, the report argued.

It backed government plans to give patients access to their medical records by 2015, calling for the BMA, RCGP and other groups to help define how this could work.

NHS Future Forum report
The NHS Future Forum report, published on Tuesday, delivered recommendations on its four workstreams: integration, information, public health, and education and training.

The integration workstream, led by Manchester GP Dr Robert Varnam, recommended the NHS Commissioning Board should use the GP contract to incentivise integrated care.

NHS Future Forum chairman Professor Steve Field told GP the forum would not specify how the contract should change. But he said it was important GPs embrace integration in their roles as both commissioners and providers.

The report said federated practices would be able to play a 'much greater part' in delivering integrated care, citing evidence that groups covering populations between 40,000 and 70,000 are best placed to offer a wider range of services and improved access.

Professor Field said that practices working together in a more federated and integrated model was 'the way forward'.

Meanwhile, the report said all providers of NHS-funded care should 'make every contact count' and advise patients about healthy lifestyle choices in every consultation.

Proposal criticism
This proposal was criticised by RCGP chairwoman Dr Clare Gerada ahead of the report's publication, but Professor Field said it was not about telling GPs to 'go through a checklist of 101 things every time they see a patient'. He said: 'We know that brief interventions for alcohol use work and that talking to people who come in with an STI about safe sex is sensible. We do this as GPs already.'

The report also backed longer GP training. Professor Field said: 'GP training should be lengthened, but it's how you do it that is important.

'It's also about the quality and experience doctors are getting during training. We heard GPs are not getting enough experience of people with complex mental health issues during their training, for example.'

NHS Future Forum recommendations

Integration

  • Overhaul GP contract to promote integration of practices.
  • Clinical commissioning groups must show ability to integrate during authorisation process.
  • Explore ways to pool health and social care budgets.

Public health

  • Build promotion of healthy living into day-to-day NHS work.

Information

  • All patients to have access to medical records by 2015.
  • Hospital discharge summaries made available to GPs.

Education

  • More flexible NHS career pathways.
  • Longer GP training.

The NHS Future Forum also urged the DH to urgently support the development of PROMs that evaluate patients' experiences across whole journeys of care, and within and between services.

It added that there is a need for the NHS and social care to learn how to use patient-generated comments on all forms of social media as a means of improving services.

Professor Field said: 'We know people make comments on Twitter and Facebook about doctors and clinical care. If the NHS fights to avoid patients' comments then it is a losing battle. We felt the NHS needs to recognise that information is powerful and important.'

Editor's blog: Will 'incentivising integration' mean a quality premium by the back door?

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