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.
- 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.
- 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.
More on primary care
- Read the overview of this report for GPs:
- Catch up with Chris Ham's blog: Making general practice fit for the future
- Watch Rachael Addicott's audio slideshow: Making the case for family care networks
- See our commentary and analysis around primary care
- Read the press release for this report: 'Family care networks' – the future of primary care
- See further articles on this report from Chris Ham and Rachael Addicott
- We are holding an event on primary care reform in summer 2014. To find out more or attend, please contact email@example.com