Speaking at a Westminster Health Forum event last week, partnership review chair Dr Nigel Watson said he was opposed to integration schemes that put general practice management in the hands of hospital trusts.
The New Forest GP said practices should instead be focusing on forming community-level partnerships, integrating care around primary care networks (PCNs).
‘The idea that hospitals can take over general practice I think is an incredibly bad idea,’ Dr Watson said. Running GP practices was ‘a different kettle of fish’ that hospital trusts rarely understood, he added - warning that hospital bosses may prioritise other services over primary care and withdraw funding.
The warning from Dr Watson follows the integration of practices with hospitals in some parts of England, including trust takeovers of eight practices in Wolverhampton and seven practices in Northumbria - both of which involve GPs giving up their independent contractor status to become subcontracted to the trust, with partners becoming salaried employees.
GPonline also reported in March that some GP practices in London were considering a switch to large-scale integrated care provider (ICP) contracts. ICP contracts are described in the NHS long-term plan as allowing ‘the contractual integration of primary medical services with other services’ in order to create ‘greater flexibility [and] achieve full integration of care' - but GP leaders fear the 'dangerous' move could undermine general practice in the area and open the door to privatisation.
‘Hospitals generally do not understand primary care and [I have] major concerns about where hospital priorities would be and the disinvestment that could occur,’ Dr Watson told GPonline. He added that key strengths of the GP partnership model - including freedom to innovate, autonomy and the ‘ability to implement change at pace’ could be lost.
But he added that primary and secondary care services should work together to achieve the goal of ‘fully integrated community-based healthcare’ set out in the NHS long-term plan.
Primary care networks
‘I actually think we do need greater integration with hospitals,’ Dr Watson told the conference. ‘But, rather than them taking us over, we need to pull their services out into the community.' He said PCNs - set to go live across England from July - could lead this process.
Dr Watson said PCNs should have ‘specialist diabetes teams’ who conduct clinics in the community rather than in hospitals. ‘Only those patients with very complex real problems should be going into hospital clinics,’ he said. ‘We should deliver it all in the community.’
Criticism of hospital integration with GP practices from the partnership review chair comes just weeks after Northumbria LMC medical secretary Dr Jane Lothian said that GP integration with hospitals could be a good thing for GPs. She described the Northumbria Primary Care (NPC) subcontracting model as a ‘forerunner to PCNs’ which saved several practices in the area from closure.
Dr Watson told GPonline that alternative arrangements where ‘hospitals hold the contracts’ could be seen as an option ‘in some areas where the partnership model is not working’.
But he added that the onus was now on the NHS to fix fundamental issues with primary care to avoid this. ‘You can’t make the partnership model more attractive unless we make general practice a better place to work,’ he said.