'Family care networks' – the future of primary care

In future, ‘family care networks’ with GP surgeries at their heart should provide a wider range of services for patients outside hospitals, says a report on the future of primary care, published today by The King’s Fund.

These networks would enable GPs to strengthen their role as providers and co-ordinators of care in collaboration with other staff working in the community and some hospital-based specialties.

NHS experts have long called for a shift in the way care is provided, with more services delivered closer to people’s homes, in order to meet the needs of an ageing population and the increasing numbers of people living with multiple long-term conditions. The report argues that most GP practices are too small to do this on their own and need to work together in federations or networks to achieve the necessary scale.

The report includes case studies from four localities where practices are working in this way. These practices are providing additional services beyond those required under their core contract making use of the flexibilities that do exist, but are generally not taken advantage of by many other GP practices. This innovation is often dependent on local leaders taking the initiative to build on the core requirements of existing contracts. However, more radical options are needed if practices are to adapt to changing patient needs and provide integrated services in the community alongside other providers. 

Commissioning and funding general practice: making the case for family care networks proposes a new GP contract, to sit alongside existing arrangements, which would:

• fund a defined population (the registered list) which would be determined by a combination of population need and the range of responsibilities included in it - bringing together funding for general practice with funding for other services
• require practices to link up with others to work at scale and benefit from pooled expertise and resources
• be focused on the outcomes that providers would be expected to deliver under the contract not on how they deliver them, offering providers greater freedom to innovate and collaborate 
• facilitate a shift to proactively managing the health of their local population and responding quickly to patients in crisis.

This would encourage family care networks to provide a wider range of services than most general practices are currently delivering and to work with community nurses, health visitors, pharmacists and social workers to deliver all but the most specialised and complex care outside hospital. This should include out-of-hours care and ensuring that services are available 24/7 to meet urgent care needs.

Chris Ham, Chief Executive at The King’s Fund and one of the report’s authors, said: ‘This new funding and commissioning model for primary care could offer GPs an important opportunity to lead the way in finding new and innovative ways of working. At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring money into general practice if GPs take responsibility for providing and co-ordinating a wider range of services. GPs are well placed to do this because of the registered lists of patients, but it would also be possible for trusts providing hospital and community-based services to take on the leadership role, working with GPs as partners.’

Rachael Addicott, Senior Fellow at The King’s Fund and the report’s lead author added: ‘Our research with GP practices that are already starting to work in this way showed that to improve the quality of patient care you needed to ‘win over the hearts and minds’ of GPs and local providers. A significant investment in people and in leadership and organisational development is a must if the new family care networks are to have the capabilities they need to succeed.’

The report highlights some further considerations.

• There would need to be effective governance measures in place to deal with any conflict of interests.
• Clinical and financial risk management would require networks to cover populations in the range of 25,000-100,000.
• Networks would need a range of capabilities to manage the contract successfully and well-developed clinical leadership.
• Providers would need to develop sophisticated means for contracting and incentivising within their networks.

The report concludes that sufficient time is required for the new contract to be implemented and evaluated so that there is time for modification and adaptation. It suggests that at least five years will be needed to assess whether the expected benefits are being delivered.