Birmingham pilot scheme will change face of general practice

Will franchised health centres improve care or control GPs? asks Tom Ireland.

It has been almost a year since Heart of Birmingham PCT unveiled its plan to move its 76 mostly single-handed GP practices into 24 'franchised' health centres. The PCT's chief executive, Dr Sandy Bradbrook, told GP this month about how he hopes a new type of contract will end the 'limitations' of the GMS and PMS contracts and guarantee higher quality care.

If the scheme is a success, he said, it could be rolled out to other deprived areas.

The aim of the franchise deal - which will be implemented in each of the 24 health centres - is to introduce an all-encompassing version of the APMS contract, with an ambitious set of standards that providers must adhere to.

The deal will include everything from compulsory services that fall outside of standard core GMS work, to new measures of GPs' attitude and courtesy.

Hostile reaction
Despite a hostile reaction to the plans in Birmingham and among the wider profession, just over half of GPs in the area have expressed an interest in the scheme and 14 have asked to pilot it.

Birmingham LMC secretary Dr Robert Morley described the original proposal as 'the scariest document I've ever seen', and maintained that GPs were being 'corralled' into the scheme. Dr Morley said the franchise strategy was only created to move GPs into the 24 new premises whose construction was agreed years ago under a multi-million-pound LIFT deal.

Mr Bradbrook admitted that the original Corporate Franchise Strategy, now renamed the Complete Care Franchise (CCF), had been badly received, but said more GPs had signed up to the scheme than he had expected.

This could be to do with his clear stance on practices that do not sign up: they will not receive any more investment because 'they are not part of our strategy', he said.

The government is watching this PCT's attempt to overcome its health inequalities closely - the scheme was highlighted as an example of innovation in the NHS Confederation's report on polyclinics earlier this year and Mr Bradbrook said the DoH had been supportive.

If the plans were a success, and the PCT drove up its standards of primary care by 2010, Mr Bradbrook believed the CCF could work in other deprived inner-city areas.

'It could be applied elsewhere. It's possible it's more applicable for inner-city areas. It certainly is a helpful approach where you have a lot of isolated practices and therefore limitations on the range of things they can deliver,' he said.

Extending roll-out
The PCT has also called for trusts in other under-doctored areas to be granted the power to create new local contracts to control GPs' organisational and clinical standards.

While Mr Bradbrook was not keen to describe exactly what would be asked of GPs under the new contract, Heart of Birmingham's director of public and patient involvement, Rehana Ahmed, revealed a series of measures apparently borrowed from the retail industry.

'It's important to get this front-of-house element right. Patient experience in Heart of Birmingham PCT is poor. We are very poor at things like access and communication and general politeness and courtesy.

'There are small changes we can introduce, like name badges, that will deliver immediate improvements,' said Ms Ahmed.

Such comments will only fuel GPs' original fears about the CCF - that evidence-based patient care is being replaced by a more superficial form of customer service.

New work practices
However, recent investigations by GP have suggested that young GPs are more open to new ways of working - 52 per cent of trainee GPs told GP they would work for a private sector provider and many seem more receptive to being monitored on things like access and attitude (GP, 8 August).

Crucially, the workload under such a contract is still unknown - directed and local enhanced services that would usually be voluntary will be a compulsory part of the contract. Pilot schemes are only just starting to determine the standards, services and workload franchised GPs will have to provide.

For GPs having to decide whether or not to sign up to the scheme now, it is still too early to know what will really be expected of them.

Franchise Uptake

76 - Practices currently serve Birmingham. More than half are interested in moving to new health centres

35 - What do gps think?

We asked our panel of 35 GPs aged under 35 for their views

  • Dr Raj Thakkar, Wooburn Green, Buckinghamshire - "The idea fills me with dread. It is another way to control GPs and take away their autonomy. The government is imposing more targets for the same money."
  • Dr Osman Bhatti, Newham, East London - "I think as young GPs we are always looking at new ways of working - some of the older principals would not be as accepting, though."
  • Dr Shimnaz Nazeer, Swansea - "It may interest new GPs due to the current shortage of jobs, but there may have been good reasons for not initiating it in the past."

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