Call to deny smaller practices GMS contracts and allow hospitals to bid for them

GMS contracts should be open to hospitals and barred to practices with fewer than 35,000 patients, and without access to scans and specialists, according to a leading healthcare commentator.

Nigel Edwards: ‘There aren’t enough generalists in our hospitals and not enough specialists in primary care.'
Nigel Edwards: ‘There aren’t enough generalists in our hospitals and not enough specialists in primary care.'

Nigel Edwards, senior fellow at The King’s Fund and director with global healthcare group KPMG, was asked to come up with a radical idea during a debate at think tank The King’s Fund in central London today headlined Moving care closer to home; slogan or solution?.

Mr Edwards, a former policy director at the NHS Confederation, said: ‘You want a radical idea? How about you can’t have a GMS contract unless you have between 35,000 and 40,000 patients, you have access to diagnostics and specialists and this is also available to hospitals?’

Earlier in the debate he said there was growing evidence that British primary care was struggling with the management of ‘quite a lot of long-term conditions’.

Mr Edwards added: ‘There aren’t enough generalists in our hospitals and not enough specialists in primary care. The answer isn’t to make more of our overstretched primary care but to help specialists work in primary care.’

Dr Mark Newbold, chief executive of Heart of England NHS Foundation Trust, east Birmingham, said the urgent care system was on the verge of failure. He said the problem locally was an inability to discharge because of a lack of support.

GP Dr Howard Stoate, NHS Bexley CCG chairman in south-east London, said successes had been achieved locally with specialists working more closely with primary care. ‘If you try to reform the service to save money you will fail. You have to define what hospitals are for. If you reform with the intention of improving care, you will succeed.’

GP Dr Stuart Sutton, of Newham CCG, east London, said; ‘There is a lack of GPs. We should be investing in primary care because GPs manage risk. We should also be encouraging more people to choose primary care because fewer and fewer of our doctors want to become GPs.’

Professor Nick Bosanquet, professor of health policy at Imperial College, central London, said international studies showed involving secondary care consultants with primary care in managing conditions including COPD had resulted in reduced hospital admissions.

However, Renata Drinkwater, chief executive of the Expert Patients Programme CIC, said patients with long-term conditions preferred specialist not generalist help.

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