Large practices and subcontracted care key to NHS integration, says Monitor

GP practices need to become larger and charities or private companies could commission NHS services on behalf of clinical commissioning groups (CCGs) to boost integration, Monitor chief executive David Bennett has said.

David Bennett: call for larger practices to integrate care

Speaking at the NHS Alliance Conference in Bournemouth last week, Mr Bennett called for practices to expand and said that as the role of hospitals was ‘diminished’ a shift of work into general practice would require a ‘restructuring of primary care’.

‘I think almost certainly the current trend towards larger practices needs to continue,’ he said.

Mr Bennett added that he supported ‘the notion that you have practices offering a broader range of services, including services that are much better integrated with [other] services.’

The Monitor chief executive also argued that for CCGs to better integrate care, one option was for them to commission a single ‘prime’ contractor who would then commission services on the CCG’s behalf.

He said: ‘One idea I think that is rightfully gaining currency is the idea that what commissioners might do is contract with a prime contractor and that they in turn then subcontract to a set of further providers who provide between them all the care that is needed.’

Bedfordshire CCG chief clinical officer Dr Paul Hassan said that the prime contractor model described by Dr Bennett was one good way for CCGs to commission services on the basis of outcomes.

He said that at the moment commissioners might hold multiple contracts with different providers for one condition area, for example muscular skeletal services, but none of those serves would be coordinated or joined up.

Dr Hassan said: ‘What you really want to do is say to somebody: "There’s the money, these are the outcomes we want,  you go into partnership or subcontract with the local acute providers to do what they should be doing, you’ll do all that sort of detailed stuff and we expect you to give us these outcomes".’

‘It’s commissioning for outcome-based integrated care, because you’re not saying to them: "In order to do this you’ll need to run so many clinics", you’re saying: "those are the outcomes we want, you’re the experts".’

North Derbyshire CCG chairman Dr Ben Milton added: ‘What some of these new commissioning methods allow and facilitate is for the providers to actually do the integration themselves. Because suddenly they have a vested interest to do it because of the way the contract is written.’

Dr Hassan said that private providers, charities and even federated groups of practices could bid to provide services as a prime contractor.

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