Exclusive: Practices could merge into hospital-led organisations under Labour plans

GP practices could be swallowed up by hospital-led integrated care organisations under Labour's plans to transform the NHS, according to shadow health secretary Andy Burnham.

Andy Burnham: Practices would have choice to merge with hospital-led bodies (Photo: Alex Deverill)

Mr Burnham spoke exclusively to GP after a barnstorming speech at Labour's annual conference in Manchester on Wednesday, a day after leader Ed Miliband revealed that a new £2.5bn NHS fund would help pay for 8,000 new GPs to improve access, if his party won the next election.

The shadow health secretary admitted that as well as employing an army of salaried GPs, traditional practices could also be integrated into Labour's planned hospital-led bodies.

Under the proposals, a Labour government would require all hospital trusts and other NHS bodies to ‘evolve’ into integrated care organisations (ICOs), which would provide all health and social care in a local area.

Mr Burnham has stressed that GPs would be ‘at the centre’ of new multidisciplinary teams of health and social care professionals within the ICOs.

The precise configuration of services would be devolved with council-led health and wellbeing boards controlling pooled commissioning budgets.

Mr Burnham has said that while he does not want to sweep away the independent contractor model, which could still be appropriate for some, he would offer a new model of salaried GPs working for ICOs. GP leaders fear this could spell the end for traditional general practice.

Choice for practices

Practices could continue as part of ICOs, Mr Burnham told GP: ‘It can fit as a partner in the integrated care organisation,' he said, but this would depend on local circumstances and would be for local leaders to decide.

Asked if existing practices could be absorbed into ICOs in some cases, Mr Burnham said: ‘If that works for them. If they wanted to stay separate and work in an agreed partnership... in the end what matters is the idea of one team.’

The former health secretary received two standing ovations during a speech in which he savaged the Coalition's reforms and promised to make the general election a ‘battle for the soul of the NHS’. 

He told GP after his speech that he hoped many of the 8,000 new doctors announced by Mr Miliband would be employed to work in the new ICOs. ‘The idea is we are bringing through a new generation of staff to lead change. To specifically work towards integration.’

While the £2.5bn fund - which would be raised from a 'mansion tax', a levy on tobacco companies and a tax-evasion clampdown - could be used to support traditional general practice, Mr Burnham said, the money was ‘about investment for the reform that we are going to need, and building the NHS of the future’. The focus should be on getting new GPs into ICOs, he said.

Put aside loyalty

He called on GPs to put aside loyalty to primary care in favour of building ‘one team’. ‘I think the NHS has been riven by division for too long. These divides don't help the public; people fighting for their organisations and their parts of the system as opposed to making things better.’

But Mr Burnham agreed with GP leaders, who said it was not necessary to abandon independent contractor status to achieve his ‘whole-person care’ model of integration.

‘I do agree with that. And I'm not advocating it. But I think, for some young people who are not choosing general practice at the moment in the numbers we would want, it might appeal to them to work differently.

'To work as part of an integrated organisation where some of your practice might be in the community, in the home, you might spend part of your week working alongside staff in A&E. Or maybe on the wards, to help make the transition back to home. To me, that is rethinking generalism.

'It won't work for everybody, and nor am I trying to dictate to everybody, but I think it's right to be open-minded about how general practice might evolve.’

'Engine of integration'

Mr Burnham said the ‘engine of integration’ would be his ‘year-of-care budget’, which would integrate funding around individuals’ needs.

‘I know people will look at these plans and think: is this a hospital takeover? But the year-of-care budget is really important because it turns the financial tide around, that currently drags to the hospital and in future will push back the other way towards the community and the home. And that, in the end, starts to answer some of the big challenges that at the moment are threatening to overwhelm general practice,' he said.

If the current failures of social care are addressed, he added, it would take pressure off general practice.

Asked if Labour would reverse the withdrawal of MPIG, Mr Burnham said he would review the withdrawal timetable and review all GP funding, including the Carr-Hill formula and the QOF, ‘in the round’.

But he would not commit to reinstating the correction factor. However, ‘no practice should be forced to close. That is an absolutely clear position', he added.

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