Dr Mike Bewick, a former GP in West Cumbria, said the combination of a growing shortage of GPs and the changing needs of patients and local populations, would require a major restructuring of primary care.
The advent of co-commissioning by CCGs, and the need to provide services ‘at scale’, meant it was now ‘squeaky bum time’, he told a Westminster Health Forum conference in London.
‘This is the time when we actually have to say what we are going to do. And I am going to say just two things that I think are going to be true.
‘One is that in 10 years’ time the term independent contractor will be anachronistic and probably it will be gone.
‘And the second is that we will not talk about primary care, we will talk about out-of-hospital provision and out-of-hospital providers.’
GP shortage damaging partnerships
He said the lack of new GPs being trained meant that ‘we are going to lose doctors from the frontline very, very quickly’, and this would impact on the partnership model of general practice.
‘If you look at primary care, more than 50% of the doctors are salaried. There will be a force majeure to move away from a partnership type organisation because it will not serve them. And equally if you cannot recruit to partnerships you will need to think of something different.’
Dr Bewick said that ‘organisational nihilism’ in the NHS was preventing the system developing to meet changing priorities.
Primary care unsustainable
‘I do not believe that the current organisational structure of primary care is sustainable or, increasingly, desirable.
‘I do believe that in the end, the whole of the out-of-hospital service needs to come together to form a more integrated service.’
He expected new provider organisations to develop, each covering populations of about 300,000 – the average size of a CCG. ‘The provider at scale is in the six figures. It is not in four or five figures.’
Pharmacists and other healthcare professionals would be better utilised to fill the gaps left by GP recruitment problems.
But the move to large-scale primary care provider organisations would not mean the loss of local, personal healthcare services, said Dr Bewick.
‘I do not think we should be confusing that with not delivering healthcare by people you know in your locality. Localism is in my blood.
‘We should be forming organisational mergers with either community trusts or secondary care, or with other providers from other sectors. Providing they have the values of the NHS at their heart, I am not too worried about who delivers but more how it’s delivered and the outcomes for patients.’
How will the co-commissioning of GP services by CCGs change primary care? Find out more about our conference: Commissioning Primary Care 2014