Quarter of GPs ready to swap practice contracts for collaborative deal

One in four GP partners are willing to ditch their existing practice contracts and join a collaborative funding deal across their local area, according to polling by a leading think tank.

Contract (Photo: Paul Starr)
Contract (Photo: Paul Starr)

Research on collaboration in general practice by the Nuffield Trust think tank reveals that the proportion of GP practice-based staff now working as part of a formal or informal collaboration has risen to 81% - up from 73% in 2015.

Responses from 565 GP practice staff showed that more than half (51%) are part of a formal collaboration, while a further 30% are part of an informal arrangement.

But the polling reveals that although a majority of GP partners (53%) say they are unwilling to give up their existing GMS, PMS or APMS contract, 27% are ready to ditch these deals and become an associate practice in a local collaborative arrangement such as a multispecialty community provider (MCP) or a Primary and Acute Care System (PACS). The rest were unsure.

Accountable care organisations

The finding suggests that significant numbers of GP practices could be prepared to abandon independent contractor status and join full accountable care organisations, which could bring together a broad range of healthcare services for an area's population under single provider contracts.

However, GPC chair Dr Richard Vautrey warned the profession against being 'seduced into MCP or accountable care organisation contracts that require them to sacrifice the guarantees they have within their current contractual arrangements'.

NHS England revealed earlier this year that every practice in the country would be expected to join a 50,000-patient 'local care network', but with the option to retain independent contractor status.

Federations were the most commonly reported form of collaboration, the Nuffield Trust poll - carried out in association with the RCGP - found, with 45% of GPs working in this model. One in four said their practice was part of a network, while 7% were part of a 'multi-practice organisation in a single region' and just 5% were part of a super-partnership.

Almost all CCGs (98%) who responded to questions from the think tank said that they had actively encouraged practices to form collaborations. But three quarters said that a lack of time and staff capacity was the greatest barrier, along with doubts from practices about the benefits of joint working.

Almost half of collaborations were long-standing arrangements set up more than two years ago, while a quarter were set up in the past year.

GP collaboration

A fifth of GP respondents said their practice was part of two collaborative arrangements, and 5% said their practice was part of three or more - suggesting that a complicated picture of overlapping schemes has emerged as practices are encouraged to work together.

Collaborations ranged in size from under 50,000 patients to more than 200,000, with access, sustainability and moving NHS work into community settings the key priorities - each shared by around half of collaborations.

Collaborations formed more than two years ago were more likely to report having been able to improve practice sustainability.

The report's authors said: 'The trend towards collaborative working has continued, but time and work pressures have made it difficult to progress, along with other barriers such as staff shortages, practice finances, and competing priorities (e.g. STPs).'

They pointed out that only around one fifth of collaborations that had partially or fully achieved a goal of improving GP access had received national funding, suggesting improvements are possible without extra financial support.

GP sustainability

However, they warned that 'improving sustainability, staff experience, clinical quality and patient engagement were more difficult to realise', and called for more work 'to understand what enablers could help collaborations make better progress'.

Dr Vautrey told GPonline: 'Good collaboration does not depend on giving up a practice's GMS or PMS contract and practices should not be seduced into MCP or ACO contracts that require them to sacrifice the guarantees they have within their current contractual arrangements.

'This is completely different from the days when practices took on fundholding responsibilities or moved to PMS. This time it is likely to be a one-way street to a fully salaried and managed service.'

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