Integration with hospitals can make general practice sustainable, says top GP

Vertical integration schemes that re-shape GP practices as subcontractors to hospital trusts can help make primary care more sustainable, an LMC leader has said.

Contract (Photo: Antonio Guillem/Getty Images)
Contract (Photo: Antonio Guillem/Getty Images)

Northumbria LMC medical secretary Dr Jane Lothian said that the creation of Northumbria Primary Care - a ‘wholly owned subsidiary’ of Northumbria Healthcare NHS Foundation Trust - in 2015 helped save several GP practices in the area from closure.

The organisation is one of a number of integration models emerging across England. GPonline reported last year that a hospital takeover of 18 practices in Wolverhampton could be copied across England. Some GP practices are also considering a switch to large-scale integrated care provider (ICP) contracts- a model described in the recent NHS long-term plan as allowing 'for the first time the contractual integration of primary medical services with other services’.

BMA leaders have warned of a potential loss of independence for practices that choose to give up control of their contracts, either through vertical integration or ICP deals - but some GPs are choosing to go ahead with the move anyway.

GP subcontractors

Northumbria Primary Care (NPC) is a group of seven practices, all of which are subcontracted to the local foundation trust. ‘GPs can keep their names on the contracts and hold the contracts but everybody is an employee of Northumbria Healthcare,’ Dr Lothian told GPonline. ‘All GPs are salaried but some of them choose to keep the title "salaried partner".’

Dr Lothian describes NPC as a 'sort of forerunner to primary care networks' - the groups of GP practices covering 30,000-50,000 patients being formed under the five-year GP contract agreement unveiled earlier this year.

Although networks do not affect practice contracts in the way that the NPC scheme does, there are similarities. Dr Lothian says: ‘There are common policies, procedures and all that sort of stuff you’d expect from a big organisation. They also have two pharmacy technicians across the group… It saves GPs time and - because everyone’s an employee of the same [organisation] - you can then have a lot of cross-cover happening between practices so you can move staff around very quickly.’

She added: ‘Quite a few practices who have had various difficulties have gone to NPC and it did help those practices to keep going and perhaps even stop them handing their contracts back. I think there are a lot of smaller practices who are feeling isolated who have gone to [NPC] for different reasons - they offer the support of a bigger organisation.’

GP workforce

The group operates under a ‘central management structure’, with a clinical executive GP and a site manager for each practice, and one senior manager ‘who’s like a chief executive’.

The model has also helped boost recruitment and retention of GPs in Northumbria, Dr Lothian says.

‘Practices can much more easily accommodate people who want to do flexible working patterns,’ she said. ‘If somebody says they don’t mind what practice they work in so long as they’re only working specific days, that can work. So it is attracting a lot of people who want to do portfolio careers - they want to do two or three sessions a week and they don’t want the responsibility of having to go to the same practice every week at the same time. I think that a lot of academics are doing it, some of our [medical] politicians are doing it - that sort of thing.’

Dr Lothian added: ‘Practices have got to realise that we’ve got to embrace a variety of models if we’re going to survive because we haven’t got people in legions coming forth wanting to be traditional partners and we’ve people wanting a whole variety of different working conditions and working patterns and this model does allow it.’

GMS contract

GPC chair Dr Richard Vautrey voiced concern over the move. ‘When practices are on the edge they may reach out to others to help reduce their risks,’ he said. ‘However, practices giving up their GMS contract to be part of these groups risk losing control of their ability to independently advocate for their patients and direct their service development. There is also a risk of services being tendered out and taken over by private organisations.’

He added: ‘Practices should instead use the control they have with their existing contract to work together with others through a primary care network.’

Dr Lothian said that there had been ‘a lot of antagonism’ over practices’ involvement with NPC, adding: ‘There’s been a lot of suspicion that the trust is trying to take over the world and that practices would lose autonomy but I say to people - how much autonomy have you actually got?

‘One size doesn’t fit all and one model doesn’t fit all. Yes there’s a definite danger and you have to make sure that the people who are running [the model] understand primary care, but we had a very stable management in Northumbria who were familiar with primary care and they worked very very hard to understand how it worked and I think they do now understand it very well.'

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