GP representatives, meeting at their annual conference in Newport on Saturday voted for locality networks to control ‘hard budgets’ and direct commissioning of LESs.
GPC Wales’ deputy chairman Dr David Bailey said the proposals were the last chance for GPs to design joined up services and make themselves indispensable to the NHS.
But critics warned without investment GPs could be 'set up to fail’.
The conference motion on localities - partnerships between local health boards and GP practices set up to plan and deliver primary and community care to populations of around 50,000 people - also called for them to directly employ community staff, set local pathways and prescribing guidelines, and influence Health Board policy.
Discussions are ongoing with the Welsh government over local, professional management of community nursing, budgets for locality work and commisioning of enhanced services, reforming the primary healthcare team and the redesign of chronic disease management with devolved budgets, according to GP leaders.
Supporting the motion to confernce, Bro Taf LMC's Dr Sarah Morgan said GPs should support locality networks if they involved all appropriate local health and social care providers, and had control over budgets.
‘You have to have more than just a voice at the health board and the ability to influence’ she added. ‘You have got to, as a locality, say: 'This is what we are going to do. And provided there are no duplications… This will happen.'
‘Then, and only then, will general practice have become engaged. Then, and only then, will we have true primary care driving forward the agenda for our patients with the money we need to do that.’
‘Localities are the only way’, she said, ‘for the health boards and Welsh government to put the money where their mouth is.’
GPC Wales’ deputy chairman Dr David Bailey said localities were not a panacea, but they were an opportunity to mend the primary healthcare team and create joined up services designed by GPs rather than managers. ‘They give us back a sense of control’, he said.
‘They are our last chance. Our last chance to run community nursing for the benefit of patients rather than the benefit of hospitals. The last chance to develop resources chronic disease management within primary care designed by GPs with resource following it. And the last chance to hold budgets where we can actually do something quickly.
‘We can either make ourselves indispensable to the NHS, or we can go back to our silos.’
Speaking against the proposals, Dr Phil White from GPC Wales and North Wales LMC, said localities were a management structure which had achieved nothing in the few years since they were formed.
‘The potential is there, if they were to function’, he said. ‘We need to be a small federation of practices.’
There is no money to give budgets to locality networks, he said.
Morgannwg LMC's Dr Ian Harris agreed localities were a good idea in principle, but when they had tried to make changes they had been warned off. ‘Now we are being invited to re-engage’, he said, ‘but the backdrop to this is a GP workforce with consultation rates rising at 4% a year, and impending surge of GPs leaving the profession…’
‘And it's this workforce that’s expected to take on budgets, commissioning, directly employing and managing community staff, and driving Health Board policy.’
‘Are we being set up to fail’, he asked. Health boards must invest in community and primary care before most GPs will want to engage with localities.
But Dr Morgan warned LMC representatives it was ‘time we stopped moaning and gave some solutions’.
‘Let’s give a decent helping hand and say, done properly, with good faith, this could be a solution. Let’s give it a go.’