The Royal Wolverhampton NHS Trust has already taken control of 10 practices through its 'vertical integration' programme - and has begun work to take over a further eight. To join the programme, practices give up their independent contractor status and become subcontracted to the trust, with partners becoming salaried employees.
NHS bosses from 17 health economies in other parts of England have contacted the trust because they are keen to 'replicate the model', its integration director revealed last week.
LMC leaders blamed soaring workload for forcing partners to give up control of their practices, and warned that heavyweight financial backing from a hospital for a select few could leave other practices to 'implode' because they were unable to compete.
The exodus of GPs from partnership roles could open the door for hospitals to expand into primary care, amid warnings from the BMA that one in 10 practices could be forced to close by 2022.
Speaking at a King’s Fund event, Royal Wolverhampton NHS Trust integration director Sultan Mahmud said the vertical integration model could expand on a national basis. ‘We now have 10 practices and we’re expanding into Staffordshire and Walsall, so this is growing,' he said. 'On top of this there are 17 economies at the moment across England that have approached us to replicate the model.’
Wolverhampton LMC medical secretary Dr Gurmit Mahay said: ‘From an LMC perspective, it is frankly disappointing to see GPs are unable to run their own practices as they have done for over 70 years. I believe it is due to the immense pressure under which GPs perceive themselves to be working currently.
‘The trust budget in Wolverhampton is 10 times that of primary care, and so it wields a lot of weight and can put that behind its own practices, disadvantaging the remaining practices through sheer competitive forces.'
But Dr Mahay said struggling GPs may be tempted to join the vertical integration scheme, hoping for a ‘safe haven where they relinquish the management and regulatory burden of running a practice’.
Divisional medical director at the Royal Wolverhampton NHS Trust Dr Mona Sidhu - herself a GP whose practice has been taken over - said integration was a positive move which equips GPs with the necessary resources to provide better patient care.
Also speaking at the King’s Fund event, Dr Sidhu said: ‘It wasn’t about more money in my pocket or more money from the trust - it was purely to drive better patient care. And we wanted to remove the primary and secondary care divide… and make sure our incentives were aligned. And the only way we thought our incentives could be aligned was if we became salaried, if we gave up our independent contractor status and subcontracted our GP contracts.’
She explained: ‘I’m still a GP, I own my own premises, I hold a GMS contract but I am subcontracted to the Royal Wolverhampton NHS Trust. This is an option we came to after exploring various other options, this was the most sensible to get us to where we wanted.’
Dr Sidhu said that benefits of the programme - which she says has made her feel ‘empowered to do [her] job properly’ - include reduced workload, access to HR, paid-for indemnity, unified policies and ‘robust governance processes’.
Since its inception in 2016, the hospital trust says its vertical integration programme has freed up 50,000 GP appointments - 400 per month per practice - and reduced emergency hospital admissions by 11%.
However, Dr Mahay argued that the loss of independence 'is not good for the profession, and I think not good for the GPs in the longer run'. He said: 'Stress can come with a relatively lower workload but when accompanied by a loss of control - ie someone else deciding not only what needs to be done, but how and when.
‘Inevitably there will be a point of critical mass when independent general practice in Wolverhampton will implode and I guess for some of us, that is when we leave the room and turn out the light for the last time.’
Earlier this year, Londonwide LMCs chief executive Dr Michelle Drage told GPonline that she thought the NHS should ‘stop trying to integrate GPs with hospitals’.
Mr Mahmud told GPonline: ‘The focus of the trust is to now build on our learning and work constructively and in partnership with all GP groups, Wolverhampton CCG, Wolverhampton City Council, the Black Country Partnership NHS Trust, patient groups and the third and voluntary sector to provide the best outcomes and experiences possible for our population.’