The GPC has warned that any move to force practices to unwillingly merge or share back office staff would contravene the practice-based contract.
In January, the NHS Future Forum called for the GP contract to be rewritten to incentivise greater practice integration.
Just over a year ago, a DH-backed report by the Foundation Trust Network suggested practices may have to share ‘airline check-in’-style appointment systems and lay off staff to cut costs (GP, 18 November 2010).
Now DH officials plan to adapt a tool created to drive efficiency savings in individual practices to a model that can be applied across clinical commissioning group (CCG) areas.
The NHS Institute’s ‘productive general practice’ tool helps practices cut duplication in office work, reduce variation in referrals and increase the number of appointments offered.
Dr Dewji: 'If variation between practices leads to outcomes that could be improved by cutting that variation, that is what we need to do'
Dr Mo Dewji, England’s national clinical lead for the DH’s Quality, Improvement, Productivity and Prevention (QIPP) programme, said the department was now looking to pilot the scheme on a larger scale.
‘If there is variation between practices that leads to worse outcomes, we need to work out if it is appropriate – some may be, some is unexplainable,’ he said. ‘If that leads to outcomes that could be improved by cutting that variation, that is what we need to do.’
NHS Alliance chairman Dr Michael Dixon said a DH focus group working with senior GPs was looking at how the post-reform NHS can ‘drive improvements in primary care’.
‘CCGs won’t commission primary care themselves, but they will have a role in improving primary care in general practice,’ he said.
‘Peer pressure is going to be a big issue, with practices working closer together and offering more work currently done in hospital.’
The approach would involve ‘being more proactive than we’ve been in the past’, he added. ‘Not Big Brother, but a level of collective self-improvement that there previously has not been a mechanism for bringing about.’
Birmingham LMC secretary Dr Robert Morley said many GPs would be forced to join multi-practice partnerships to cope with the bureaucratic burden from Care Quality Commission registration, QOF and other requirements.
He said it would be ‘very important’ for practices to avoid losing control of their back office functions.
‘Once we end up blurring the distinctions between our business as general practices and the wider NHS, with commissioning budgets etc, we are going down a very dangerous road,’ he said.
‘In a worst case scenario, we could all end up being employees of privatised commissioning support units.’
GPC deputy chairman Dr Richard Vautrey said general practice was already ‘far and away’ the most efficient part of the NHS.
‘GPs are bearing a huge workload while resources are decreasing,’ he said. ‘There are huge pressures on practices already. We need to shift resources into primary care in a way we have not seen in recent decades.’