GPs should be able to expand practices to employ hospital consultants, says NHS England

GPs should be able to form expanded group practices which also directly employ hospital consultants, NHS England's new chief executive Simon Stevens told the RCGP annual conference.

Simon Stevens: RCGP conference speech
Simon Stevens: RCGP conference speech

Speaking at the conference in Liverpool, Mr Stevens backed RCGP calls for more GPs and more funding for primary care.

He proposed radical new freedoms for GPs and hospitals specialists to join forces to promote more personalised and joined-up care for patients.

Mr Stevens argued that an ageing population, with many patients suffering from multiple health problems, means that it's time to break down the overly rigid barriers between GP and consultants that have been carved in stone since the NHS was set up in 1948.

He pointed out that in other countries, GPs and specialists often work alongside each other, with GPs even having admitting rights to hospitals, and with more outpatient care delivered in doctors' surgeries not in hospitals.

GPs should take on consultants as practice partners

Mr Stevens argued that the NHS nationally should not dictate how services are organised in each part of the country, given the different needs of towns, cities and urban areas. But said that as part of a soon-to-be-published NHS Five Year Forward View, NHS England and its national partners would support local communities that wanted to develop new care models.

One radical new option would be for GPs to form expanded group practices which also directly employ hospital consultants (or take them on as practice partners). These new combined groups might bring together GPs, consultant physicians, geriatricians, psychiatrists, community nurses, therapists and pharmacists, perhaps some social workers, and other staff.

They could also take on ownership of the local community hospital and use it as a hub to add more local services, such as hi-tech scans, outpatient chemotherapy, and dialysis. These new groups could be taken on a delegated annual budget to look after the whole health care needs of their group of patients.

A second new option is that under some circumstances - for example in deprived urban communities where local general practice is under strain and GP recruitment is proving difficult - hospitals might for the first time be permitted to open their own GP surgeries with registered lists. This would also have the benefit of unlocking the investment power of NHS foundation trusts to help modernise primary care premises in their local areas.

In both cases, the expectation is that services would do a better job of looking after people at home and stopping people having to be admitted to hospital as an emergency for lack of preventive care. Mr Stevens pointed out that now 30% of emergency patients admitted to hospital are there for less than a day, which suggests that better primary and social care could have prevented the admission.

Mr Stevens said: ‘The national debate on the NHS is now picking up steam, and GP services are rightly at the centre of it. But alongside more doctors and more funding, we also need new and better ways of caring for patients, especially older people at home.

'GPs themselves say that in many parts of the country the corner shop model of primary care is past its use-by date. So we need to tear-up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists, and where patients with chronic health conditions are increasingly passed from pillar to post between different bits of the health and social services.’

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