NHS long-term plan to pool funding and tie practices to 50,000-patient networks in contract overhaul

GP practices across England will be expected to sign 'network contracts' under reforms set out in the NHS long-term plan that will pool funding and link practices with community care across 50,000-patient populations.

GP contract reform (Photo: iStock.com/simarik)
GP contract reform (Photo: iStock.com/simarik)

A long-term plan for the NHS published on Monday promised 'at least' a £4.5bn increase in funding for primary and community care over the next five years.

But the funding boost is set to come alongside demands for a major overhaul in how services are co-ordinated. The long-term plan says that NHS England has now learned enough from 'vanguard' areas trialling new models of care through the primary and acute care systems (PACS) and multispecialty community provider (MCP) schemes 'to commit to a series of community service redesigns everywhere'.

The document reveals: 'The £4.5bn of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people.

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NHS long-term plan to deliver 'at least' £4.5bn primary care funding boost

'As part of a set of multi-year contract changes individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will flow.

'Most CCGs have local contracts for enhanced services and these will normally be added to the network contract.'

The long-term plan acknowledges 'multiple challenges' facing community healthcare services and general practice - highlighting 'insufficient staff and capacity to meet rising patient need and complexity'.

It says: 'GPs are retiring early and newly-qualified GPs are often working part-time. Reform of the GP contract in 2004 improved the quality and income of primary care practitioners, but relative investment in primary care then fell for the rest of the decade.'

GP pressure

The document adds: 'Use of locum GPs has increased and there is shortage of practice and district nurses. The traditional business model of the partnership is proving increasingly unattractive to early and mid-career GPs. Patient satisfaction with access to primary care has declined, particularly
among 16-25 year olds.'

Plans to drive GP practices into networks through revised contract arrangements come alongside a pledge in the long-term plan that could force practices to compete with digital first providers to offer online services to their patients.

Over the next five years a 'right' to digital consultations will be extended to all patients in England - either through their existing practice 'or, if they prefer, from one of the new digital GP providers'.

GPonline reported last year that the government was considering reforms to the GP contract to accommodate services such as GP at Hand, and the long-term plan confirms plans to review out-of-area patient registration rules and the GP funding formula to ensure 'digital first practices' are safe.


GPC chair Dr Richard Vautrey told GPonline that the network contract plans were 'part of our current negotiations' on the GP contract.

'Essentially this will be a contract that builds on practices' current contract and enables them to work across a network of 30-50,000 patients. The network contract is the vehicle to enable practices to do this in a supportive way.'

The GPC chair said the network deal would not be obligatory, but added: 'We would hope that once we have agreed the changes practices would want to do it.'

He added that he was confident that plans to guarantee digital GP consultations for all patients would see NHS England invest in providing all practices with the IT infrastructure to offer these services to patients.

Dr Vautrey welcomed the promise of an extra £4.5bn funding for community and primary care set out in the long-term plan, highlighting 'long-standing lobbying' by the BMA and others for greater investment in general practice.

RCGP chair Professor Helen Stokes-Lampard said plans to add network membership into practice contracts would 'build on models that have been shown to be successful'.

But she added: 'It is vital that this is done in a way that minimises disruption for hard pressed GPs and their practices and enables progress to be made in a way that protects the ability of GPs to deliver care in the way that best meets the needs of their local communities. It is also vital that continuity of patient care is prioritised.'

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