In this latest blog, management consultant Scott McKenzie considers the new GP contract and shares his first impressions.
I’ve read through the new GP Contract and followed with interest the numerous articles, comments and social media posts. For me, this is a big step in the right direction, with good investment in to General Practice, a plan to tackle the workforce issues, which is essential, and the introduction government backed indemnity scheme. In short, I’m impressed and so is my client base. Feedback from them has been positive (in the main).
If the aspirations included within STPs and the development of Integrated Care are to happen, it will require that part of the overall STP/Integrated Care solution is the goal of achieving one, high quality and standardised approach without unwarranted variation, becomes the reality within local systems.
Given that every model of Integrated Care is predicated on the registered lists of the General Practices inside their geography, it is imperative that General Practice is engaged before decision are made, rather than consulted once the decisions have been made. For me this requires General Practice to operate with scale and through some form of entity that protects the Practices and vitally allows them to be represented with one voice.
This contract is a significant shift in the direction of travel for General Practice and provides a level of optimism for the future not seen for quite some time. The key now is how General Practice responds and how the CCGs work with them to implement the changes required. The biggest change of course is the need now for General Practice to come together in Primary Care Networks of 30,000 to 50,000 patients to deliver their “Network Contract”. The successful ones will ensure local systems are built around core General Practice, which is exactly how it should be.
While forming a Primary Care Network has been mooted as “optional”, what is already clear is that the Network Contract will include approximately 40% of General Practice income (40% for top performing Practices and less for those who perform less well, where I have seen it as low as 30%), meaning it is far from optional. Indeed, in all my conversations I haven’t found a Practice that could manage on core contract alone.
While for many the formation of a Primary Care Network is a natural progression, as they already have a strong and long-established history of collaborative working, for some this is going to bring a real challenge, particularly where relationships either don’t exist or are strained/difficult at best. Even is those circumstances the Practices are going to have to find a way to come together to attract the additional income in the Network Contract.
It is therefore now essential that General Practice takes the time to explore its future model and how locally you want to work “at scale”. It is also essential that CCGs ensure the funding intended to support The Primary Care Networks development, arrives with the Networks.
There are four quick points to try and help. These are things to consider and have clarity over at the start of the journey:
- Outside of the NHS Long Term Plan is there a catalyst for the scaling up of practices? Is there established good working relationships/affinity/trust between the constituents?
- What is the geographic fit? How are other health and care services aligned with the population to be served?
- What is the size of the combined registered population to be served and what is the evidence that this size is the right size to scale and the right size to care?
- How will the new scaled-up registered population’s care need be assessed and then MDT workforce be developed to meet that need?
Answering these is the basic start point for development.
Lastly, while GP federations barely get a mention in the new ways of working, it is worth remembering that while some now dismiss the need for a GP Federation, my sense is that’s a potential missed opportunity. A GP Federation offers scale to General Practice and provides one voice for General Practice across a whole Health Economy. It can also employ on behalf of the Networks the new staff being suggested for General Practice, which includes, Pharmacists, Paramedics, Physiotherapists, Physician Associates, Sign-posters and Social prescribers. This also makes the evolving Integrated Care Systems/Partnerships easier to develop. Primary Care Networks of 30,000 to 50,000, which could number 4 or 5 and possibly more across a health economy, overarched by a GP Federation therefore looks an excellent model and it is one we have worked with a number of times. Before people start folding their federation company they need to be certain that’s the right move.
In summary, the new GP Contract looks like a very good opportunity to redesign and rebuild General Practice, supporting it to remain fit for purpose and ready to respond to the challenges, both immediate and future. As highlighted be Professor Helen Stokes-Lampard, who said: “Investing in general practice is investing in the entire health service – and this new contract promises to do just that, in the best interests of our profession, the sustainability of the NHS, and the care we deliver to more than 1m patients a day across the country. If implemented correctly, this contract could cultivate a profession that future doctors are eager to join, and where existing GPs want to remain – and can enjoy – working.” I couldn’t agree more.