London GPs could be forced to federate in NHS overhaul

GP practices in London could be forced to federate to expand patient care and offer seven-day services under plans to transform primary care in the capital, but will keep their independent contractor status.

Professor Clare Gerada: NHS London role

Vacant hospital sites could be sold to raise funds for primary care premises improvement, or handed to practices to develop, under plans set out by NHS England's regional office for London.

But GPs will not be forced to relinquish independent contractor status, despite support for the move from former RCGP chairwoman Professor Clare Gerada - now NHS England's clinical director for primary care transformation in London.

A report by NHS England, Transforming Primary Care in London, warns that a growing population, coupled with 16% of London GPs nearing retirement age, means general practice in the capital is not sustainable in its current form.

'Tweaking at the edges will not be an option – London needs solutions that will sustain primary care for the next 50 years,’ the report said.

Enhanced services could be commissioned from federations instead of individual practices in future, the report revealed. ‘There is a need to end the piecemeal reward of enhanced services from general practice – a process that for any small enterprise adds to the financial uncertainty and inability to plan effectively for the future. Service developments need to be appropriately contracted for and funded with opportunities to tailor these to local population needs where required,’ it said.

Published on Thursday as part of London's contribution to NHS England's General Practice – A Call to Action programme, the report says practices could be forced to federate to reduce back-office costs and offer more services such as diagnostics, as well as seven-day primary care services.

GP practices in London could offer more online consultations, Professor Gerada said, as part of a move to 'segment' how care is delivered to different patients.

‘We may start to segment, within these federations, how we deal with certain patients,' she said. ‘So for example, you young ones - when you get a cold or whatever - you really do want quick access, which you may be quite happy to do via an online form.

‘For our complex, chronic patients, we of course need to be continuing to deliver face-to-face care.'

Professor Gerada said she 'wouldn’t be surprised' if around 40% of patient contacts with primary care could be handled online. 'Transactional' contacts with patients, such as appointment booking and repeat prescriptions 'will be nearly 100%’ handled online, she added.

Asked about her recent calls for a debate on GPs' contractor status, Professor Gerada said: ‘This is not about getting rid of the independent contractor model. You can have both contracted and salaried within a federated model.

‘This is not about looking at different contractual arrangements.’

The report sets out why London's primary care needs reform, but further proposals will be published in January together with a consultation. A final decision is due to be made in late spring or summer.

NHS England is now working with NHS Property Services to earmark surplus NHS premises in London for GP practices to use, or to sell to invest in existing GP premises. Underused state-of-the–art GP practices will also be identified, as part of the review.

NHS England regional director for London Dr Anne Rainsberry said many London practices were keen to work in federations. ‘The vast majority of practices in London want to do this. What you have to do is enable them to do it by the way we commission them, by the way the funding flows. There are lots of ways that we will want to encourage the system to migrate to this.'

She made clear that practices not linking up with others would come under pressure. ‘As a commissioner if you end up in a few years hence where every Londoner can access this apart from a small part of London, then I think it our job to take action. The majority of GPs want to move to this.’

Londonwide LMCs chief executive Dr Michelle Drage backed incentives for practices to federate but warned against coercion.

‘Let’s incentivise practices to work together. Start with what needs to work on the ground. Practices need to be released from the pressures of excessive and inappropriate demand. They need a better supply of community, mental and social services, centred around practices.’

She was cautious about plans to use vacant hospital sites for GP practices. ‘If there happens to be a vacant hospital or NHS trust building that ticks all the boxes and it is what practices and patients want, that’s fine. If it is simply a way of disposing with premises they don’t want and dumping it on practices who are then faced with escalating service charges, then we don’t support it.’

The findings of NHS England’s nationwide consultation, Improving general practice – a call to action, are due to published early next year.

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