In an interview ahead of the Conservative party conference last week, the Prime Minister continued this renewed focus on the NHS by announcing plans for an alternative GP contract. The government presented the new contract, set to be introduced by April 2017, as a way to support its commitment to achieving a ‘seven-day NHS’. Unsurprisingly this upset the British Medical Association, which asked the government why it was relying on soundbites rather than choosing to address the real issues facing general practices across the country. It upset the Royal College of General Practitioners too, with chair Maureen Baker saying that Cameron had ‘caused even more stress and worry’ for GPs struggling to deliver high-quality care within diminishing budgets.
Looking beyond the focus on seven-day services, what the government seems to be proposing is a new contract that gives groups of GPs the opportunity – if they want it – to work more closely with a range of other services to provide more integrated care for their patients. This is not a bad idea.
It’s not a new idea either. Last year The King’s Fund published a report making the case for what it called ‘family care networks’, involving groups of GPs working with community nurses, physiotherapists, social workers, pharmacists and other health and care professionals – including some specialists currently working in hospitals – to offer patients a wide range of services in the community. These networks would be funded by a single budget covering populations of around 25,000 to 100,000 people. As well as providing more co-ordinated services for people when they become ill, the aim of family care networks would be to improve the broader health and wellbeing of the populations they serve.
Our proposals were followed by criticism from the British Medical Association too. But the potential benefits for GPs of working in this way are considerable. They include being able to offer extended access to care and provide a wider range of services than many practices could on their own. Working in teams (which extend beyond just GPs) also offers the opportunity to develop more flexible working arrangements to help reduce stress and staff ‘burn-out’. Group Health in the United States is a good example of how this has been done elsewhere.
Many GPs in England are already providing a foundation for these ideas by working together in networks, federations and other ways. The Vitality Partnership, where Cameron gave his speech back in May, is just one example on a longer and growing list. Only last week a group of 35 GP practices in another part of Birmingham announced plans to work together as a single partnership to meet the pressures they collectively face. The Royal College of General Practitioners has been advocating these kind of scaled-up GP models since at least 2008.
The challenges of working in this way – particularly if these GP groups are to be given a new contract to manage a wider range of services for their patients – should not be underestimated either. They include being able to develop the skills and capabilities needed to manage large contracts and associated risk, align incentives within networks, and establish new forms of governance where accountability is clear. Lessons can be learnt from similar approaches in the United States in the 1980s and 1990s, where many medical groups failed and ended up going bankrupt because these challenges weren’t effectively met.
Since Cameron turned his attention back to the NHS in May, the government has faced opposition from hospital consultants over proposals around seven-day working and from junior doctors over plans to introduce a new contract. The government’s latest proposals for the new GP contract have been met with a similar reaction, but behind them lies a good idea. An optional contract combining general practice with a wider range of services is something that could help improve care for patients – as well as improving the working lives of GPs.
- Read our report: Commissioning and funding general practice
- See our work on primary care
- Catch up with our analysis of health and social care under the new government
- Find out more about our forthcoming conference: Pressure points: how can we support primary care to cope with growing demand?