GP out-of-hours 'super contract' could push out local providers

Plans to create an integrated urgent care 'super contract' covering much of north London would push out local providers and affect patient care, one GP-led provider has warned.

Out-of-hours service: fears over impact of large providers

CCGs covering five boroughs across central north London, with a population of almost 1.4m, are in discussions to develop a joint, integrated GP out-of-hours and 111 service.

The preferred model would see a single contract, with either an alliance of of providers or a lead provider offering a service tailored to fit local CCG circumstances. At least one CCG has already approved the plans.

Dr Mike Smith, chief executive and medical director at Haverstock Healthcare, which provides GP urgent care centres in Camden, told GP his organisation would be unable to provide a service on that scale, and the model risked sacrificing local knowledge which could affect care and quality.

Sheep farming

‘General practice is like Welsh sheep farming,' he said. ‘You know your hills and you know your sheep - and I don't believe we would know our hills and our sheep with a contract that big.’

Dr Smith said there would be only a few big providers who would be able to deliver the proposed service.

He said: ‘Nothing beats localism in terms of understanding what your challenges are. As soon as you try and put a competitive market in there, what the priorities for the patient are come lower down the list. Such a contract would be daunting.'

The scale of the new service would ‘certainly’ affect patient care and quality standards, he added. ‘You would have to wait and see whether it changed it for the better.’

Loss of local services

A report to Camden CCG’s governing body in September acknowledged that local GPs were concerned that the size of the contract could mean a loss of a local service. The report said the development of an ‘alliance of providers’ or ‘lead provider’ model would satisfy the need for a local service and allow providers to work closely with GP providers.

The preferred model, the report said, would deliver ‘economies of scale’. But Dr Smith said that was not necessarily the best thing for patients.

He called on the CCGs to open a large public consultation to find out what patients’ priorities are. ‘Do economies of scale matter to patients? Probably not,' he said. ‘Does the ability to see an out-of-hours GP in a timely manner matter? I suggest it does.’

A spokeswoman for Camden CCG said: ‘The out-of-hours service is still under discussion with all five CCGs across North Central London. The proposed preferred option is to procure an integrated service (combined out-of-hours and 111), that will be delivered across the five North Central London (NCL) CCGs.

Bids from consortia

‘The service will be procured in a way to allow joint bids from a consortium of providers, or for a lead organisation working with a number of local providers. 

‘Camden CCG, alongside the other NCL CCGs,  will have full involvement in the procurement process, with local doctors leading in planning the specification, and service requirements developed to ensure that local needs are met.   

‘In Camden, there has been pre-engagement work with all GPs via the locality meetings where the possible options have been discussed and modified as a result of their input. In line with the agreed plan and statutory obligations there will be local input and engagement with our public, stakeholders and GPs.’

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