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Commissioning and funding general practice

Making the case for family care networks

As England’s population both expands and ages, so the demands on primary care will grow. Within the current commissioning and funding system innovative models of primary care provision are already being used. This report describes examples of these through four case studies in different areas of England. It also highlights how the existing system is imperfectly understood, particularly regarding contracts.

Building on ideas articulated in previous work, the report argues for a new approach that brings together funding for general practice with funding for many other services. It would entail new forms of commissioning, with GPs innovating in how care is delivered. Over time, the report foresees ‘family care networks’ emerging that provide forms of care well beyond what is currently available in general practices.

Key findings

  • Demographic changes, increasing multi-morbidity, clusters of risk factors and the rising needs of frail older people are piling pressure on primary care.

  • General practice is well placed to respond to these pressures, due to its registered list of patients. This permits practices both to tailor treatment and act preventively.

  • When developing integrated community services, there must be engagement with social services to help people stay independent and out of hospital. Making high standard out-of-hospital services available 24/7 is essential to halting the rising use of hospitals.

  • Currently practices cannot fully meet their ambitions to develop innovative care due to challenges posed by structural instability, shifting accountabilities, provider engagement and payment models.

  • The case studies demonstrate considerable innovation within the current system, but also great complexity and instability. Organisational change and loss of organisational memory compound this. Technicalities of contracting are imperfectly understood, inhibiting the flexibility that already exists.

Policy implications

  • A rapid, radical shift is needed from the current model of general practice to the use of federations and networks of practices able to work on the scale required for effective integration of services.

  • Without changes to commissioning and funding arrangements, the argument for new models of care will remain theoretical. At the heart of this approach is the use of a population-based capitated contract under which providers would be expected to deliver defined outcomes for the populations they serve.

  • Practices will need new skills in various areas: risk stratification of the population, quality improvement, collaborative working with other providers, greater capability in managing financial and clinical risks.

Read the overview of this report for GPs: Joining up services in the community: GPs leading the way

Summary presentation

Dr Rachael Addicott, Senior Research Fellow at The King’s Fund, explains why a new approach towards primary care delivery is needed, and looks at how ‘family care networks’ – which entail new forms of commissioning, with GPs innovating in how care is delivered – can provide forms of care beyond what is currently available in general practices.

Download Rachael's slideset: Making the case for family care networks.