Dr Nigel Watson, chief executive of Wessex LMC and head of the Southern Hampshire MCP, one of six sites piloting the new at-scale contract, told the LMCs conference that the contract would be for populations of 30,000-plus and based on a registered patient list.
Practices taking on the contract will be given a population budget and be held to account against a range of outcomes measures, he said.
Seven-day, 8am-8pm working appeared to have become less of a priority under the MCP (multispecialty community provider) contract since plans for the area-wide GP contracts were first announced, Dr Watson said.
‘The seven-day working that was core to this when it was announced has been mentioned less and less,’ he said. ‘I wouldn’t say it has totally disappeared. Access is an issue the contract is seeking to address, but seven-day working is less prominent in the discussions now.’
The contract will have to be held by a ‘legal entity’ and pilots are currently looking at what form that might take. Dr Watson said this was important because practices would not want to take on the risks of budgets for various services, particularly if they would be working with other MCPs and providers to deliver them.
The new contract will not replace practices’ PMS or GMS contracts, but will ‘sit on top of them’, said Dr Watson.
However, he said that the flexibility of allowing GPs to put their ‘contracts into abeyance for a year or two’ had also been discussed.
‘We’ve argued that practices are going into the unknown so there has to be a right of return,’ said Dr Watson. ‘The problem with this is that if you develop this too far you will come to a point where you can’t return because you are so integrated into the system that you can’t restablish your original contract.’
The six pilot areas will take on the MCP contract in shadow form from April 2017. These are Southern Hampshire, Dudley, Manchester, West Wakefield, Modality in Birmingham and Whitstable in Kent.
Dr Watson said the new contract would be key to the success of the NHS.
‘NHS England wants this to work because it hasn’t got a plan B,’ he said. ‘Unless we can deliver care in a community-based setting with the resources to do it, the NHS is going to struggle more and more year on year.’
He said it was vital that NHS England delivered on the promises it set out in the GP Forward View for this to succeed. ‘If it’s just window dressing and NHS England does nothing the NHS is stuffed. If it wants to deliver general practice as it is described in the Forward View it needs to stump up the resources.’
GPC chairman Dr Chaand Nagpaul said that the MCP contract would be entirely voluntary and that it was important that any practice in a ‘new model’ area that was offered the contract should ‘carefully consider what the options are.’
Dr Nagpaul added that the vanguard sites were not the only areas that ware delivering innovation or working at scale. He said that the GP Forward View had promised £171m to support working at scale and ‘we need to make sure that money reaches practices with no strings attached.’
He added that working at scale could provide a lifeline for struggling practices if it was properly resourced.