Alternative GP contract could drive practice integration

An alternative GP contract should be set up alongside GMS to encourage larger-scale primary care provision, according to a report commissioned by senior NHS managers.

Dr John Grenville: new contract unnecessary
Dr John Grenville: new contract unnecessary

Research commissioned by the former NHS Midlands and East SHA found contracts and commissioning must incentivise integration to allow primary care to meet rising demand.

The researchers said a contract could offer practices incentives to merge or integrate, or CCGs could be handed powers to commission primary care services that force practices to link up.

GP leaders hit out at the plans, warning a new contract was unnecessary, and called for proper investment in the current system to give GPs space to consider alternative models.

The report, by the King’s Fund and Nuffield Trust think tanks, studied 21 different models of primary care provision from around the world to see which could best provide solutions to the current pressures on UK general practice.

The authors of Securing the future of general practice said successful models should provide an extended range of services, focus on population health, tailored care for multi-morbidity, clinical governance, professional management, and staff career development.

To achieve these aims an alternative, outcomes-based contract, to run in parallel with GMS, should set objectives for providers, leaving implementation details to be developed locally.

The authors said: ‘The contract needs to be crafted by NHS England in a way that encourages groups of practices to take on a collective responsibility for population health (and ideally also social) care across the network of practices.’

The extent of risk assumed should depend on local circumstances, they added.

The report cites the example of a US primary care contract: ‘a five-year voluntary contract made available to physicians who wished to take on a capitated budget in return for delivering on mutually-agreed quality and financial outcomes.’

Alternatively, CCGs could themselves commission additional services from GPs using a range of local contract models to encourage ‘the formation or extension of primary care federations and networks, with practices coming together to bid to provide new services’.

GPC deputy chairman, Dr Richard Vautrey, called for proper investment in the current GP contract.

‘Practices that are properly resourced for the work they do will have the space and time to consider alternative models. This could include working together with others.’

Derby LMC secretary, Dr John Grenville, said practices were already working together. Efficiencies were possible through working together, but ‘practices should probably not be incentivised to grow and grow and grow’, he said.

‘We need to keep the model whereby the controlling minds of the organisation are actually at the shop floor level,’ he said.

Birmingham LMC executive secretary Dr Bob Morley said a move to larger practices was 'the only way GP-led independent contractor general practice can survive', but warned this could put large commercial providers 'in a strong position'. He backed incentives for practices to work together, but said: 'I do not believe such a model requires a new contract.'

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