New models of care being piloted in ‘vanguard’ areas across England under a £200m project to test care integration could lead to radical changes to GP contractual arrangements.
GP leaders warned that the projects had created a ‘free for all’ in parts of England that was untenable in the long term and could fragment services.
In Hampshire, GP leaders admit that a vanguard project could lead to some practices becoming salaried departments within a large community services provider organisation.
In Lancashire, plans for a single budget for all patients’ health and social care needs could also see core GP funding merged into wider NHS budgets.
Pooling budgets usually excuse to take resource out of general practice
GPC deputy chairman Dr Richard Vautrey told GP it was unimaginable that funding for specialist tertiary services would be pooled under integrated care plans.
‘General practice should be the same,’ he argued. ‘You should have a core funding offer for it – the foundation on which the rest of the service is built.
‘This would be a red line. Pooling budgets is usually an excuse to take resource out of general practice.’
The GPC is opening talks with NHS England over the implications of vanguard projects.
Dr Vautrey added: ‘We need to tread carefully. There appears to be a free for all in parts of the country.
‘We do need to see genuine collaboration and co-operation between organisations, and we want to see service development. You don’t have to undermine the core contract that supports general practice to do that.’
Wessex LMCs chief executive Dr Nigel Watson said the Hampshire vanguard pilot would not consider pooling GP funding ‘to start with’.
He was clear that practices themselves were driving the reforms, and no attempt would be made to force them to give up independent contractor status. But he argued that for many practices the current system was unsustainable.
Funding was already being leached out of practices, Dr Watson said, and pooled budgets may not make this worse. Creating high-level salaried GP consultant roles within an integrated care model could help free GPs from the administrative burden of running practices, and attract doctors back to the profession, he said.
Dr Hugh Reeve, clinical chairman for Cumbria CCG, told GP he liked the independent contractor model and foresaw future arrangements maintaining practice units that patients knew.
But he warned that with general practice under severe pressure, some areas were considering a move to a salaried GP service within an integrated care model, and that major contractual change could happen if GPs supported it.