New care models are political vanity project, says NHS England GP

The new care models programme is the latest in a string of reforms driven by politicians seeking a legacy, a top NHS England clinical official has said.

GP and NHS England London clinical director of emergency care Dr Tom Coffey said he was ‘not a fan’ of new care models and that vanguards or multispecialty community provider (MCP) schemes made him ‘lose the will’.

Speaking at the annual conference of Londonwide LMCs on Thursday Dr Coffey, who also advises London mayor Sadiq Khan on health policy, said he was ‘wary’ about organisational change, which 'usually produces two years of paralysis'.

‘Politicians love a legacy,’ said Dr Coffey. ‘So they come to power and say, what can I do, what can I change? Because they can't change the relationship with the patient in the consultation room, which is what matters to patients, they think, let's change the system. So, Andrew Lansley has changed it, Alan Milburn has changed it. Now Simon Stevens is going to try to change it.’

NHS integration

Patients, said Dr Coffey, weren't interested in integration between GPs and hospitals, but about joining up services in the community.

The London GP said practice federations were the best solution. ‘The reason I got involved in a federation isn't because I would have done it if I'd had a blank piece of paper. It's because I know people want to make us change. I thought, what model can I choose that would give us control with minimal change, which would allow us to direct it so we are integrated with social care, mental health and voluntary sector.

He added: ‘So, like you , I'm not a fan of models, but we cannot pretend that people aren't trying to create these things, so I would just grab the opportunity and do it that way.’

Hurley Group partner and former RCGP chair Dr Clare Gerada warned that some GPs could be getting involved with new care models without properly understanding the implications for them.

GP federation

She said: ‘We are encouraged to [federate] because of economies of scale. Well, there aren't any economies of scale unless you close practices down. There are very few functions that can be done at the top of the office. 

She added: ‘Now, it's this new model has come and everybody jumps. And doesn't understand the financial implications, the implications for themselves as providers.’

Dr Gerada said she wished ‘we'd stop talking about models’.

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