Scrapping partnership model will not solve crisis in general practice, say NHS leaders

Scrapping the partnership model and moving to a salaried service will not solve the crisis in general practice, NHS leaders have told MPs.

UK Houses of Parliament
NHS leaders were giving evidence to the House of Commons Health and Social Care Committee (Photo: Scott E Barbour/Getty Images)

In the latest evidence session of the Health and Social Care Committee's inquiry on the future of general practice, NHS leaders cautioned against 'jumping to a single solution' across the country, such as hospital trusts employing GPs, when there is currently very little evidence to back this model.

NHS Confederation chief executive Matthew Taylor told MPs that the partnership model was not at odds with the current move towards greater integration across the NHS, social care and other partners and said it made little sense to try and change a system that most GPs want to retain.

He said: 'I think the partnership, model brings many benefits, particularly in terms of the kind of commitment that general practitioners make for that model

'I don't think the partnership model is in any way in tension with primary care networks or federations operating at scale. I don't think that the major reforms we need to achieve are unachievable with the partnership model, so why would you want to take on something which a lot of people care about and which matters to them and motivates them.'

'The challenges are hard enough without having a battle we don't need to have,' he added.

Salaried service

In March this year health and social care secretary Sajid Javid endorsed a report by the Policy Exchange think tank, which called for the GMS contract to be scrapped within a decade with GPs becoming predominantly salaried within large scale providers, including hospital trusts. Earlier this month he said the current model of primary care was 'not working' and promised a 'plan for change'.

However, Saffron Cordery, interim chief executive at NHS Providers, which represents NHS organisations including hospitals and community services, told MPs that the biggest challenge facing both primary and secondary care was the workforce shortage. She said there was 'no evidence that simply being employed by another organisation' would address this.

'We shouldn't be jumping to a single solution because I don't think the partnership model is [the reason for] the challenges that exist in primary care and GP practices,' Ms Cordery said

She added that while hospital trusts employing GPs was working in some places, it was 'not a silver bullet to solve a problem'.

'There aren't actually that many trusts at the moment who are running GP practices – there's no empirical evidence on that at the moment,' she said. 'We think it's around a dozen or so, so it's not a widespread model at the moment. And, on that basis, we should think really carefully before jumping to a solution that says all GP should be salaried, that the partnership model is dead.'

GP workforce plan

Ms Cordery said areas needed to establish models that worked for local circumstances. But, she said the solution was 'fundamentally about building capacity'.

'It's about a supply of workforce – so a proper workforce plan for GPs. It's not about the the model of running the particular service in this instance,' she added.

GP and chief executive-designate of Surrey Heartland ICS Dr Clare Fuller, who recently led the review commissioned by NHS England to set out how to integrate primary care, backed the partnership model but agreed that different systems might be needed in some parts of the country.

'From a local point of view, the partnership model works very well where I currently work and I'm very much of the view that if something is working, don't mess with it,' she told the committee.

'But there are a lot of areas around the country where it isn't. And it is those areas where I think we need to look at something differently because it's our most vulnerable people that are not served well by the current model.'

An earlier session of the Health and Social Care Committee's inquiry heard that Mr Javid's decision to back the report that called for the end of the partnership model was putting GPs off becoming partners

Dr Pauline Grant, a GP partner from Southampton, said current uncertainty about the future meant that the partnership model was 'collapsing bit by bit', likening it to a Jenga stack on the brink of collapse.

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