Don't give up practice contracts for ACOs, warns GPC chair

GPs should stand up against any attempts to 'strongarm' them into suspending practice contracts to join accountable care models being rolled out in the NHS, the BMA's top GP has warned.

GPC chair Dr Richard Vautrey (Photo: BMA)
GPC chair Dr Richard Vautrey (Photo: BMA)

GPC chair Dr Richard Vautrey told GPonline it was 'absolutely explicit' that creating accountable care organisations (ACOs) alongside existing competitive tendering regulations carried a 'risk of widescale privatisation' of NHS services.

This concern was 'central' to the BMA view that practices should not give up their GMS, PMS or APMS contracts to integrate with emerging accountable care models, he said. Dr Vautrey said GP practices should retain their contracts even if they integrate with new care models, and not 'put your future livelihood or your successors’ future livelihoods at risk of potentially being run by some sort of multinational health body'.

His comments follow a strong warning from BMA chair Dr Chaand Nagpaul over the threat ACOs could pose to the health service. Dr Nagpaul wrote in his new year message that the union would continue to oppose competition and procurement legislation, which - alongside the development of ACOs - could open the door to NHS services across 'entire localities being run by commercial organisations'.

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NHS England has identified 10 areas across England in a first wave of organisations building on 'vanguard' new care model schemes and plans drawn up under sustainability and transformation partnerships (STPs) that are now developing into 'accountable care systems' (ACSs).

NHS England guidance describes an ACS as an 'evolved version of an STP', which could in turn develop into an ACO - an organisation that would hold a single contract and a capitated budget to run the vast majority of health services across a geographical area, spanning primary, acute and social care.

Under 'fully integrated' ACO models, GP practice contracts would be suspended - and their funding pooled with the wider ACO capitated budget. Partners could take a role in leading these organisations, or become salaried employees.

NHS privatisation

Opponents of ACOs fear that the NHS commissioners could be forced to put the contracts to run these organisations out to tender, opening huge chunks of the health service to being run by a private provider.

NHS England is adamant that 'the objective of the new care models programme is not to privatise the NHS' and that services will remain free at the point of use whatever the shape of the organisation running them. King's Fund chief executive Professor Chris Ham has also argued that it is 'extremely unlikely' that the development of accountable care models will result in greater private sector involvement in the NHS.

GPs working in emerging accountable care models are also hugely positive about the advantages the model could offer. Manchester GP Dr Tracey Vell - a primary care lead for the Greater Manchester Health and Social Care Partnership - says full integration or partial integration could bring advantages such as helping to improve back office support for general practice, offer better GP career progression options, chances to share and improve premises and use IT better.

But BMA leaders remain deeply concerned about the new care models, and believe that GPs holding onto their contracts can offer a degree of protection. 'Partially integrated' or 'virtual' models of accountable care systems would not involve GPs giving up practice contracts - and Dr Vautrey has urged GPs to resist going beyond these steps.

Collaboration

He said ACOs posed a 'huge risk'. 'We support the idea of closer collaboration between organisations at local level. And it makes sense to work closely with everyone at a local level - with community nursing, with social care - but if you bundle all this under one contract that has to be tendered, ultimately you are delivering that service on a plate to a potential private provider. So it is a really serious issue that could be opening up the NHS to the market in a way we have never seen before.

'We strongly advise practices to look very carefully at any ACO contract they are invited to get involved with and this is central to why we think there is no need to give up your practice GMS or PMS contract to be part of a collaborative working arrangement. Whatever happens in the future you need to be able to fall back on your national contract and not put your future livelihood or your successors’ future livelihoods at risk of potentially being run by some sort of multinational health body.

'It’s absolutely explicit - until they can remove the risk of competitive tendering there is a risk of widescale privatisation. We have seen that with some community services already, where what would be widely regarded as NHS services have been taken over by private companies when they have been put out to tender.

'That is a small scale of what could happen in the future. When you put a whole health economy on one contract that is up for tender there is nothing to stop a multinational private organisation bidding for that and winning and running that contract for the next decade. It’s there, quite clear within the legislation and until that is removed then there is a risk of privatisation.'

Some practices were coming under pressure to join emerging care models - finding themselves 'strongarmed into these deals', he warned. Dr Vautrey urged practices to have the confidence to stand against this pressure, and said that if practices were denied access to funding streams for enhanced services, for example, unless they joined, they may be able to challenge this practice under competition law.

NHS England did not respond to a request for comment.

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