Switch to 50,000-patient GP contract could be one-way street, warns GPC

GPs that sign up for population-based multispecialty community provider (MCP) contracts to deliver primary care at scale may find the deals are irreversible, the GPC has warned.

Dr Richard Vautrey: MCP deal could be irreversible

GPs in Manchester are set to become the first to be offered the MCP contract, which will replace individual GMS or PMS contracts held by practices with a population-based arrangement, the city's top GPs have confirmed.

Practices taking part will sign up to become part of a single legal entity that comprises multiple existing providers to deliver care for populations of 30,000 to 50,000 patients.

The proposed contract, devised locally with input from Manchester LMC, could offer practices a number of benefits, according to its chief executive Dr Tracey Vell.

These include allowing practices to be ‘more resilient’ by sharing staff across populations, improving workload issues and ushering a ‘return to some of the closer working relationships which were and still are the most effective’.

New care pathways

It would also allow for ‘new pathways and work streams to be defined with investment in the leadership involved’.

‘We hope that patient care will improve both in satisfaction and outcomes,’ she said. ‘[And] that staff morale will improve and recruitment and retention of staff will rise. An ambitious change of provider focus and working which is provider-led and not managerially driven will be refreshing and powerful.’

But GPC deputy chairman Dr Richard Vautrey said there were ‘huge risks’ for practices choosing to relinquish their GMS or PMS contract to sign up for an overarching MCP deal, warning that such a move was likely to be a ‘one-way street’ – regardless of whether promises for a right to return were made.

‘Practices really need to enter into these types of arrangements with great caution and realise that it could be a one-way street. The promise of a return ticket to their current status could well be illusory,’ he said.

‘As soon as you enter into such a significant change to your contractual status, you start to give up control of many things that the practice currently has direct responsibility for: staffing, premises and the freedom and flexibilities that you currently have.

GP contract

‘The risk is once you’ve started to disaggregate that and move away, it’s very difficult to move back to a practice-based funding arrangement. How do you disentangle what's related to the individual practice out of a wider pooled budget, which may well have been significantly changed because of implications of others within the MCP?

‘Even if [right to return] is promised, in practical terms it will be extremely difficult to do so. It’s completely different from the promise given to PMS practices to GMS, because they were more or less the same type of arrangement delivering and working within the same type of contractual framework.’

Nationally-agreed GMS and PMS contracts ‘provide significant protection to GPs and practices’, he added, and there should be ‘no reason’ why practices could not enter into an MCP arrangement while retaining their current contract.

He said: ‘Our proposal is that you should retain a core GMS contract within the framework of an MCP, with ring-fenced funding for practices that will protect practices and give them the confidence to engage in the MCP in a much more stable way.’

Dr Vell said: 'We are of course very aware of the issues and want to learn from what has happened to budgets and staffing within PMS, as well as build up and build on local relationships.

'There is still much to be worked out but we are putting all the mechanisms in place to ensure a lifetime offer of return as currently exists for PMS/APMS. We’ve put a lot of thought in to this locally and nationally and are genuinely excited about the opportunity it affords.'

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