More GPs will be offered incentives to be directly employed by ‘academy-style’ hospitals instead of running their own practices as independent contractors under new plans from the health secretary.
The Times reported over the weekend that Sajid Javid is set to conduct a full review of general practice, including many GP practices being run by trusts.
There would be ‘no forcible state takeover’ of GPs, but they would instead be likely to be incentivised to join trusts, the newspaper said.
This is similar to the model in Wolverhampton, where 10 local GP practices are run by the Royal Wolverhampton NHS Trust.
The Department of Health and Social Care denied claims by the newspaper that this amounted to general practice being ‘nationalised’.
In a letter to the Prime Minister, seen by The Times, Mr Javid said there are ‘considerable drawbacks’ to the current contractor system including an ‘underinvestment in prevention’.
It also said that the health secretary will launch ‘an independent review of the future of primary care’, looking at ‘workforce, business models and how GPs work with the other parts of the NHS such as hospitals’ with a view to ‘bringing together primary and secondary care’, The Times reported.
According to the newspaper, the plans aim to reduce hospital admissions by making GPs ‘do more to keep patients out of hospital’.
However, a spokesperson for the Department of Health and Social Care (DHSC) told Pulse it has ‘no plans to nationalise general practice’.
They said: ‘We are incredibly grateful for the phenomenal work that GPs do for their patients and have invested £520 million to improve access and expand GP capacity during the pandemic.
‘Now we have moved back to Plan A we will continue with our plans to tackle waiting lists and deliver the ambitious reforms needed to help our health and social care system recover.’
Changing management will not solve crises
Proposing to put primary care under the management of hospitals ‘will not fix the major workforce shortages or underinvestment’, the NHS Confederation said.
Chief executive Matthew Taylor said the idea ‘appears to be built on a false premise that hospitals are busy simply because of failures in general practice, which hardworking staff will find deeply offensive’.
He said: ‘We look forward to engaging in the independent review of primary care but like we have seen with the proposed “reform trusts”, there is a risk this latest idea could be ill thought through and will undermine this direction of travel before it has even been fully implemented.’
Responding to The Times’ claims, the BMA said it is a ‘kick in the teeth to read about our future in the press with no warning’.
BMA England GP Committee chair Dr Farah Jameel said: ‘Now is the time to invest in general practice, not to try and reinvent the wheel through a wholesale change to the model.
‘The existing model protects the vital relationship between GP and their patient and allows for individual care, rather than a top-down approach which is what general practice might become under these plans.’
General practice’s ‘high-quality, cost-effective and timely care is underestimated and poorly valued by policymakers’, she added.
The RCGP said in a statement that although it is ‘open to exploring new ideas about the future of general practice’, there ‘has to be a very good reason for changing a model that works well for patients, for the NHS and for the taxpayer’.
RCGP chair Professor Martin Marshall said that ‘considering how primary and secondary care can work better together’ is a ‘necessary exercise’.
‘[But] it is one that must recognise the current model of general practice – whereby GP practices have independent contractor status – is one that delivers exceptional benefits for the NHS.’
What is happening in Wolverhampton?
In Wolverhampton, the local hospital trust has taken over the running of 10 practices.
Royal Wolverhampton NHS Trust began providing GP services in 2017 when it announced it would be directly responsible for the delivery of care of eight GP practices as part of an ‘open-ended’ pilot. In 2019, it acquired its tenth practice.
At the time, the trust said that the acquisition means it is able to ‘redesign services’ and prevent unnecessary hospital admissions.
It also said issues around ‘scope of responsibility, funding, differing objectives and drivers will be removed’ so that ‘clinicians will be in a position to design effective, high-quality clinical pathways, which will improve appropriate access and positively impact on patient outcomes’.
Meanwhile, the Royal Wolverhampton NHS Trust and its GP practices have partnered with Babylon.
But Wolverhampton is not the only area where this is happening.
Also in 2019, an NHS foundation trust in Cheshire also took over three GP practices after partners were forced to hand over their contract over recruitment issues.
And in the same year, Sandwell and West Birmingham Hospitals NHS Trust took over three GP practices, with GPs warning the takeovers could put the trust in an ‘extremely powerful position’.
A version of this story first appeared on our sister title, Pulse.