Family care networks - the future of primary care?

General practice is at the forefront of the NHS. As well as being the first port of call for patients, it's at the sharp end of the financial and service challenges facing the service as a whole. Rachael Addicott, Senior Research Fellow at The King's Fund, explains how 'family care networks' – with GP surgeries at their heart – could be an alternative model for the future.

Why do we need a new approach?

'Primary care must change to meet the needs of an ageing population and an increasing number of people with long-term conditions. Add to this the financial pressure facing the service, reflected in a decline in the proportion of the NHS budget going into general practice, and it’s clear we are facing a burning platform.

'We've been looking at four groups of GP surgeries across England that are rising to these challenges by working in larger federations or networks in partnership with other services in the community. However, during our work it became  clear that the way that general practice is currently funded – and the complex technicalities of the different ways GPs contract for services – can be stifling, is often poorly understood and does not support the innovation that is needed to address the critical position we are in.'

What are 'family care networks'?

'We propose that GPs play a key role in leading what we've called 'family care networks'. GP practices would be at the centre of these networks, working together at scale in federations, to provide a wide range of services outside hospitals including out-of-hours care. GPs are in a unique position to take on this role, as they hold a list of registered patients with a record of their medical history, enabling them to proactively manage the health of their patients.'

How would these networks operate?

'This new approach would see large networks or federations of GPs take control of a population-based capitated contract. There would be a greater focus on GPs as providers – so delivering a broader range of services themselves – alongside taking 'make or buy' decisions about other services for the patients on their registered list.

'This would mean that funding for primary medical care would be incorporated with funding for other services (except highly-specialised care), all covered by a single contract, so simplifying the current fragmented income and contract structure.

'This approach could be a powerful means for both delivering a broader and co-ordinated range of services at a local level, and reversing the decline in the proportion of the NHS budget that is allocated to general practice.'

Should all GP practices should take on a population-based capitated contract?

'Becoming part of a family care network and holding a capitated contract should be entirely voluntary and optional for GPs. We know, from experience, both here and in the United States, that radical changes like these can fail if clinicians don't have the will, capacity or skills to manage a contract like this. This model should be taken up only where practices and federations have the capabilities and the ambition to take it forward.'

The report includes four case studies which describe innovative models of primary care. What was common among them?

'The case study sites were selected from different parts of the country but all had their use of contractual mechanisms to support collaboration and stimulate improvements in the delivery of care to their local populations in common.

'They all had different ambitions, whether that was to improve care for their frail elderly population, work more closely with colleagues in A&E, or deliver more preventive care. A key feature across all sites was that these goals had led local GP leaders to establish federations or other types of networks, to enable them to operate on a bigger scale.'

What next?

'We see this paper as an opportunity to kick-start a conversation about new models of care, and the fundamental changes to funding and contracting that are needed to make it a reality. We've deliberately not set out a blueprint for doing this, which risks further stifling innovation; now is the time to get all options on the table.

'We have tested these ideas with GP leaders and other stakeholders and our suggested approach has resonated with many. However, not everyone agrees with our suggested approach and we encourage further discussion on these issues. This debate creates a once-in-a-generation opportunity to provide the freedoms needed to empower innovative GPs and their colleagues so that they can be at the forefront of changes in primary care that have long been called for.'