Federate GP practices to bring in new funding, says King's Fund chief

Widespread federation of GP practices and a new type of GP contract are needed to fully integrate community services and encourage new investment in primary care, the King's Fund chief executive told the LMCs annual conference.

Professor Chris Ham: new deal needed for general practice (Photo: JH Lancy)
Professor Chris Ham: new deal needed for general practice (Photo: JH Lancy)

Professor Chris Ham called for GPs to lead the development of a new integrated health and social care service model called 'family care networks'.

He told LMC representatives in York on Friday that the increasing pressures facing primary care and all parts of the NHS required a new way of working to deliver more integrated services, available 24/7.

The King's Fund report, Commissioning and Funding General Practice, published in February, put forward the case for family care networks to lead this work.

New deal for general practice

Professor Ham said this would required a 'new deal' for general practice, including a new form of locally held, population-based capitation contract, based on defined outcomes for the local area.

Professor Ham said: 'Our view is the government made a cardinal mistake in 2010 in focusing too much on your role as commissioners, and insufficiently on your role as providers.

'Our view is that most GPs think of themselves as providers of primary care to their registered populations. That's what they trained to do, that's what they want to do, that's what their principle responsibility is.

'We need to refocus on that and how we can strengthen our models of primary care provision, to deal with the pressures, to provide better care, better outcomes for patients. But just doing more of the same is not the answer.

Integrated health and social care

'We need genuinely integrated health and social care teams at the neighbourhood or locality level, able to provide a rapid response, and critically, available 24/7. And that cannot happen with our current model of general practice.

He said the focus on collaborative, integrated services could bring new funding into general practice.

'Our proposition... is a population-based capitated contract, linked to defined population health outcomes.'

He said that under the new model, CCGs should co-commission primary care, with networks holding the contracts. This would also help to reinvest savings within this broad-based capitation contract into primary care.

Professor Ham added: 'We need the BMA and the RCGP to lead the debates on investment and reform: a new deal for GP, to preserve what's really good but to move beyond that into something that's even better.'

Lack of debate over sustainability

He also expressed concern at the lack of political debate about the future sustainability of the NHS in the face of increasing financial pressure.

'Our worry is we are not having a debate about that. In a run-up to an election, surely, we ought to be exposing the differences between the political parties: hearing their views, their offers on how they will deal with critically important services like theNHS. But that debate is not happening. Isn't that curious?'

'We will be challenging our politicians in the main parties to be honest, direct, to front up to what you know, what we know, what many other people know: that unless the budget for the NHS does increase, we will hit a major financial crisis.'

 

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