NHS England has said it wants every practice in England part of a 'local care network' of around four or five practices, which will become the ‘ordinary way to do business’ for general practice in the next two years. National funding will be made available to set up the networks.
The plan, part of the latest package of measures announced by NHS England to implement its Five Year Forward View over the next two years, follows comments by primary care minister David Mowat earlier this month to MPs that the general practice could move from 7,500 existing practices to 1,500 ‘super hubs’.
The Next Steps report also sets out plans to expand evening and weekend GP access to 50% of the population by March 2018 and 100% by 2019. Numbers of co-funded clinical pharmacists working in practices will be expanded from 491 today to over 900 next March and 1,300 in 2019.
GP practice team
Meanwhile, 1,500 mental health therapists will be working in practices by 2019. The GP Forward View has promised 1,500 clinical pharmacists and 3,000 mental health therapists by March 2021.
The local care networks will bring together GPs with other doctors and health and care professionals to provide a single health and care system for localities. Practice groupings could share community nursing, mental health, and clinical pharmacy teams, expand diagnostic facilities, and pool responsibility for urgent care and extended access. The plan is intended to free up GPs' time to focus on complex care.
The hubs will build on existing at-scale provider groupings such as federations, super-practices, MCPs, and the National Association of Primary Care (NAPC)’s primary care home.
NHS England has previously suggested the 30,000- to 50,000-patient hub model would become the dominant organisational form, which is considered a potential building block for larger, more complex integrated multispecialty community provider (MCP) or primary and acute care systems (PACS) new care models that bring primary, secondary and community care together.
NHS England’s director of primary care, GP Dr Arvind Madan, told GPonline the new groupings will become the delivery vehicles for implementing some of the support measures for general practice set out in the GP Forward View. The new networks will aim to provide economies of scale, collective resilience, neighbourhood multidisciplinary teams, and joint recruitment.
NHS England wants every practice in the country to join up to some form of network, Dr Madan said. ‘This now becomes the new delivery scaffolding across the system. And it may be how they organise themselves in terms of access, and population and place-based care, and how they will be meaningful neighbourhoods for services to patients in terms of the offer they get too,’ he said.
Financial support will be provided nationally to set up the hubs, including for premises and staffing, to accelerate the move to more ‘extensivist’ primary care services.
Dr Madan said that while some local care networks may choose to evolve into MCP-type new care models, all would have to have a relationship with their region's sustainability and transformation plan (STP) group. In some areas where STPs will establish more integrated accountable care systems, GP practice hubs will be ‘vertically integrated’ into the wider system with commissioners within those systems taking on delegated decision rights for primary care commissioning.
While participation in local care networks will be voluntary, Dr Madan said the incentives and benefits will ensure all practices want to sign up. ‘The local care networks I suspect will become increasingly the ordinary way to do business, as a group of practices,’ Dr Madan said. ‘That doesn't mean that everyone necessarily has to be shoehorned into one against their will. I suspect the offer will be sufficiently compelling to make it a no-brainer for every practice.’
General practice at scale
The plans will not necessarily mean practices have to merge, close or co-locate and they will remain independent contractors. ‘They can still operate as four or five different units as practices, there is no direction or prescription from us as to what that needs to look like,' Dr Madan said.
The GP leader added that many practices are already involved in some form of grouping around the 50,000 population size, so the scheme was not beginning from zero. ‘Because it feels like a natural community, people have gravitated towards it already,' he said. ‘So, I think we are are starting from an informal organic version of this across swathes of the country, now being formalised. That hopefully will accelerate it into more mature delivery vehicles for a range of things and a range of ways in which the GP Forward View can be accelerated into the system as well.’
The networks, said Dr Madan, would ‘bring back some of the joy of being a partner again, and some control or autonomy and purpose…that has somewhat been constrained in recent times.’
The Next Steps plan also set out more details on the formalisation of STPs as organisations. Sustainability and Transformation Partnerships will be non-statutory bodies for planning and providing place-based integrated health and care. STP boards will include representatives from constituent organisations.
Some STPs, initially, will be developed into accountable care systems (ACS) effectively ending the NHS purchaser-provider split and to jointly plan and provide integrated health and care services with greater control over local services. Nine areas have been named as likely candidates to develop the ACS model.
ACSs may in time develop into full accountable care organisations, with a single provider contract for all services covering their population.