Merger of GP and community care possible, says NHS England

Work by NHS England to develop primary care could include new contractual arrangements for GPs, co-commissioning with CCGs, and the merger of community and primary care services, its deputy medical director has suggested.

Dr Mike Bewick: GP and community care merger could happen (Photo: Jason Heath Lancy)
Dr Mike Bewick: GP and community care merger could happen (Photo: Jason Heath Lancy)

Speaking at Londonwide LMCs’ conference on collaborative working on Wednesday, Dr Mike Bewick, who leads NHS England’s Call to Action on general practice, due to report this month, said there was a need to ‘revisit the organisational form of primary care’.

He said NHS England was continuing to look at co-commissioning of primary care with GP-led CCGs. ‘I don’t believe we’ve actively commissioned primary care in my lifetime. It's about time we did,’ he said.

Changes would not ‘necessarily mean changing contracts, but it could,’ he told GPs from across the capital.

‘There will be different contractual elements... put forward by Ros Roughton [NHS England’s director of commissioning development] and her team to look at how we can develop primary care.’

Dr Bewick, a former GP, said that health secretary Jeremy Hunt had said ‘he couldn’t see why we couldn’t recombine community services and primary care together'.

‘Obviously there would be contractual issues and regulatory issues. But this is a time when people are thinking about new ways of organising out-of-hospital care.’

Dr Bewick told the conference there must be ‘substantial’ new resources coming into primary care from other parts of the NHS. ‘It can’t just be a few hundred million [pounds],' he said. ‘We’ve got to be taking larger amounts than that.’

He called for innovation and integration in primary care and more focus on population health. 

Dr Bewick added that the withdrawal and redistribution of MPIG and PMS funding should be seen as an opportunity to reorganise, not just a threat.

NHS England chief executive Sir David Nicholson will announce ‘further changes in terms of the allocation of funding’ for primary care to shift the balance of NHS resourcing, Dr Bewick added.

Shifts in primary care funding expected

Professor Clare Gerada, chairwoman of NHS England’s London primary care clinical board, also addressed the conference, during which Londonwide LMCs' new report, Securing the Future of General Practice in London: Meeting the Challenge, was launched.

She said the sector had an open door to transform primary care because people now realised more resources were necessary to continue delivering the current standard of care.

‘We hear continuously there is no money’, said the former RCGP chairwoman. ‘But there is money, because there is money to bail out the emergency department during winter pressures; there’s money the prime minister has found to set up innovative solutions to general practice... And there is money to build new hospitals. So there [are] resources.

'It’s just a matter of us working together as groups of GPs, whether you want to call those networks, federations, clubs, I don’t care. But groups of GPs together so that we can then work with our foundation trusts and non-FTs on an equal basis.’

She added: ‘The only way of getting inward investment into primary care is through foundation trusts; working with them to start them, releasing resource... rebadging some of their community services so that the community services actually support us.’

Professor Gerada told the conference NHS England’s London region was preparing to publish a new set of general practice standards for consultation, covering areas such as continuity, access and integration.

There could also be more moves towards co-location of primary, community and social care on single sites in London, she added.

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