Named GPs unlikely to save NHS money, King's Fund report suggests

Forcing GPs to become the named, accountable clinicians for the vulnerable elderly will have a 'limited' impact on reducing NHS costs, a King's Fund report on existing care models has suggested.

Dr McCarron-Nash: 'The camel’s back is already broken'

The government wants to make GPs in England the named accountable clinicians for the care of the vulnerable elderly to reduce expensive hospital admissions.

Health secretary Jeremy Hunt has hinted that he wants GPs in England to draw up care plans for 1m vulnerable elderly patients from April.

But a King's Fund report, Co-ordinated Care for People with Complex Chronic Conditions, published on Thursday, warns that care-coordination models showed ‘limited’ impact on reducing costs and improving cost-effectiveness.

It also warned against implementing top-down models and concluded that effective programmes understood the ‘local context’.

Intense workloads and lack of sufficient remuneration for the work involved could be leading to a lack of GP engagement in existing coordinated care models in England, the report said.

GPC negotiator Dr Beth McCarron-Nash said GPs would need more funding if they were made responsible for coordinating the care of the vulnerable elderly.

‘All GPs want to provide individual needs-based care for their patients,’ she said. 'The reality is that we are already saturated. We are struggling with demand.

‘A GP is best placed to coordinate care, but what we are not best placed to do is be responsible for care 24 hours a day. If social services don’t turn up and the patient goes to hospital, that isn’t my fault.

‘I can raise commissioning issues with the CCG but I can’t be responsible for all NHS care in my local area.'

She added: ‘The camel’s back is already broken. We can’t deliver any more without something going. I cannot see how we can take this on as well.’

The report said care co-ordinators 'need to be imbued with responsibility and power to exert influence within the local health system. Without this they can become isolated, demoralised and ineffective’.

The report continues: ‘Managers and policy makers need to be realistic about the potential financial impact of care coordination, and view the approach primarily as a quality improvement strategy rather than one specifically aimed at cost reduction.’

On implementing plans, the report said: ‘Achieving effective programmes of care coordination requires a bottom-up process to develop the building blocks for effective partnership working, rather than introducing new top-down models of care, no matter how well they may have worked in other settings.

‘Understanding the local context, then, is the key to transferring lessons from other programmes of care co-ordination.’

Authors studied five coordinated care models in England, including in Devon and Torbay, Sandwell in the West Midlands and Pembrokeshire in Wales.

The report concluded that ‘progress would have been easier if they were operating in a more integrated delivery system – for example, where purchasing, planning, organisation and governance practices were more closely aligned’.

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