Exclusive: Crown indemnity could extend to GPs under new care model contract

Crown indemnity protection could be extended to general practice under a national GP contract designed for new care models that is set to be unveiled this summer.

Greater Manchester LMCs chairwoman Dr Tracey Vell

Details of the new contract, announced by prime minister David Cameron last autumn, could be finalised for practices to see as early as August, ahead its launch in April 2017.

Groups of practices organised into multispecialty community provider (MCP) new care models, serving populations of 30,000 to 50,000 patients, will be able to sign up to local variations of the new national contract which could last for 10 years.

GP leaders in Greater Manchester, where health budgets have been devolved to local control and services are being integrated with social care as part of the regional devolution deal, have said practices there could be first to adopt the new contract.

GP contract

The MCP contract will have national and local elements. Greater Manchester LMCs chairwoman Dr Tracey Vell, who has been involved in developing the contract at both local and national level, said details could be available for practices in August.

National elements being considered included notional rent reimbursement, pension rights and crown indemnity, she said.

Dr Vell said the high cost of indemnity was making general practice an unattractive career, and inserting reimbursement into the new contract could be an incentive to encourage GPs to move to the new population-based provider models.

‘There has to be some incentives for GPs,' she said. ‘We are trying to write some of those into the contract which will be held by a [MCP] provider. So why can't we have some degree of crown indemnity to take out some of the expenses from the GPs who will be employees and working in different ways?’

General practice role

Locally, providers and commissioners will decide the scope of the MCP contract, such as whether it will encompass mental health, pharmacy, community staff, urgent care, A&E, or specialist diabetes, services for example, said Dr Vell.

In Greater Manchester 10 locality-based federations of six to eight practices are currently being developed with each appointing a GP employed as ‘system leader’ to co-ordinate integration and redesign of community services such as district nursing, and social care.

Locality federations will then choose whether to maintain their current separate practice G/PMS contracts with an overarching APMS GP-plus contract held by the federation, or whether to merge practices into the federation with a joint MCP contract.

Practice federations or MCPs will form parts of larger, wider 'local care organisations' which will include acute, community, social care, mental health services and third sector providers, collectively accountable for delivering population health, and led by primary care.

GMS contract

The GPC has warned practices that moving away from GMS to an MCP contracts could be a ‘one-way street’, despite an NHS England commitment to guarantee a ‘right to return’.

GPC deputy chairman Dr Richard Vautrey told GPonline in December 2015 that practices that sign up for MCP contracts to deliver primary care at scale may find the deals are irreversible.

Last week NHS England formally devolved its direct commissioning powers and control of the £6bn budget to local officials of the Greater Manchester Combined Authority covering 2.8m people.

Commissioners have said they intend to roll out seven-day GP services across the whole of Greater Manchester by the end of this year.

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