Integrate GP contracts with social care, NHS Alliance report suggests

GP contracts could be integrated with other primary, community and social care services as part of a transformation of out-of-hospital care set out by the NHS Alliance.

Dr Michael Dixon: vital moment for primary care (Photo: Steffan Hill)

Integrated primary care contracts could remove divisions between general practice, pharmacy, optometry and dentistry, according to a report from the Alliance, which represents primary care providers.

Such funding models, it said, could eventually be extended to cover community health and social care to provide a mechanism to transform the current ‘fee for service’ approach of some providers into ‘patient-centred, relationship-based care’.

The report said: 'A more radical approach might be to trial pathfinder projects such as integrated primary care contracts that would remove the divisions between general practice, pharmacy, optometry and dentistry. Such funding models could eventually be extended to cover community healthcare and even social care and provide a mechanism to transform the ‘fee for service’ approach of many healthcare practitioners, to a system which recognises the importance of patient-centred, relationship-based care.' 

The paper, Think Big, Act Now: Creating a Community of Care, is based on a six-month research and consultation process.

Action to support ageing population

Procrastination is no longer an option according to the report, which calls for immediate action to achieve the ‘paradigm shift required to support a growing and ageing population’.

The paper sets out a ‘community of care’ approach with general practice at the centre of a cohesive primary care team of multidisciplinary health professionals and community leaders working closely with the secondary care sector.

The Alliance called for general practice funding to be increased to 10% of overall NHS spending to allow the development of new roles within general practice at scale, more staff and improved premises. And payment mechanisms should be developed to enable collaboration between primary and secondary care.

A general practice development fund should be set up to support change at grassroots level, providing backfill or funding pilots.

Pump priming for GP integration

Pump priming could be used to enable GPs to extend primary care by forming cooperatives or integrated care organisations, the paper said.

The paper called for a new role of ‘community health connector’, a GP or other professional, who would coordinate work with other local stakeholders such as education, housing, transport and business to address social factors underlying health problems and strengthen the public health role of general practice. 

The document outlined 10 practical steps to create a 'community of care through general practice at scale':

  1. Reduce bureaucracy, restoring professionalism: Eg shift more QOF funding into DESs with less specification.

  2. Restructure the workforce: extending the role of community pharmacists and bringing them into practices. Make primary care a better place to work; new roles such as health trainer and facilitators.

  3. Transform premises: co-location with other health and social care services, or housing providers.

  4. Co-ordinate health and social care.

  5. De-medicalise care.

  6. Embrace new technology.

  7. Create community health connectors.

  8. Review the core funding model.

  9. Transformational funding.

  10. Promote self care.

NHS Alliance chairman Dr Michael Dixon said primary care was facing a ‘perfect storm of pressures’, making change likely.

‘We want to see change by design rather than default: change led by those working within the service who best understand the issues they and the communities around them face.

‘This is not all about the money. Professionals in primary care crave the time and space to spend time serving patients rather than dealing with endless paperwork and box ticking, and are open to new ways of working. But new ways of working also rely on new ways of thinking and doing. As a system, as health professionals and as the general public we need to think act responsively and responsibly to help restore the NHS and all the people associated with it to good health.

"To achieve this, we propose an incremental journey towards what we are calling "a community of care", which is based on the implementation of general practice at scale but is not all about GPs.'

Dr Dixon called the proposals a ‘defining moment for general practice and primary care’. 

‘A moment where we take collective responsibility for the health and wellbeing of our NHS, whether we are policy maker, care provider or care receiver. A moment where we commit to delivering and using the service thoughtfully and respectfully. A moment where we recognise that unless we are prepared to change both our thinking and our actions, we may pay the ultimate price and lose the national health service that has provided us with free care at the point of need for more than 65 years.’

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