King's Fund suggests GPs receive extra funds to encourage community working

A new GP contract that merges funding for general practice with that earmarked for other services should be created to encourage innovation in the community, a King's Fund report has recommended.

Professor Ham: 'These proposals could bring funding into general practice if GPs take responsibility for providing and co-ordinating a wider range of services. '
Professor Ham: 'These proposals could bring funding into general practice if GPs take responsibility for providing and co-ordinating a wider range of services. '

The proposed contract would require practices to link up with others to ‘work at scale and benefit from pooled expertise and resources’, the King’s Fund said.

It would focus more on outcomes, rather than inputs, by providing incentive payments to reward practices for meeting certain goals, and penalising those that fail to do so.

In its report on the future of general practice commissioning and funding, the King’s Fund recommended that GPs sit at the centre of family care networks that provide a wider range of services than most general practices are currently delivering.

Under the proposals GPs would work with community nurses, health visitors, pharmacists and social workers to deliver 'all but the most specialised and complex care' outside hospital. This should include out-of-hours care and ensuring that services are available 24/7 to meet urgent care needs, it said.

However, the King’s Fund stressed that the new contract should be optional rather than compulsory.

It said: 'Practices would still be able to work under the current contract including being able to provide enhanced services. However, practices able and willing to do more would have the opportunity to take on a budget with which they would form federations to deliver care and integrate with other services.'

The King’s Fund said this approach was underpinned by the recognition that GPs’ role as providers of care is more important than their commissioning role. 

It said the recent reforms have focused too much on the involvement of GPs in commissioning and too little on how the role of GPs as providers can be strengthened.

It said integrated commissioning would be needed to implement the new contract, which it said would reverse ‘the fragmentation brought about by the Health and Social Care Act 2012’.

This could mean that ‘area teams’ may eventually take on the current commissioning responsibilities of CCGs, thereby reinforcing the role of GPs primarily as providers, it said.

Professor Chris Ham, chief executive at The King’s Fund and one of the report’s authors, said the new funding and commission model could help GPs find innovative ways of working. 

He said: ‘At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring funding into general practice if GPs take responsibility for providing and co-ordinating a wider range of services. 

‘GPs are well placed to do this because of the registered lists of patients, but it would also be possible for trusts providing hospital and community-based services to take on the leadership role, working with GPs as partners.’

But Dr Chaand Nagpaul, chairman of the GPC, said there is no evidence that a wholesale change of contractual basis of general practice would deliver any real benefits to patients.

He added that general practice does not need another reorganisation to follow the 'incredible time consuming and costly restructuring' GPs have just undergone.

He said: ‘In its current form, the GP contract enforces nationally agreed standards of care across the country while allowing practices the flexibility to tailor their services to the demands of their local community.

‘The King’s Fund alternative would see GP services subsumed into wider commissioning budgets that would both make it more difficult to guarantee national standards and hinder the ability of local GPs to truly manage the services they deliver.’

* Inside Commissioning: GP contracts should enable providing or buying all but the most specialised services

* Viewpoint: Dr Kailash Chand: Why I oppose the King's Fund's primary care plans

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