Hospitals could run general practice services in underserved areas

BMJ 2014; 349 doi: (Published 03 October 2014) Cite this as: BMJ 2014;349:g6055
  1. Gareth Iacobucci
  1. 1The BMJ

NHS hospitals could take control of general practice services in parts of England to provide new investment and infrastructure for under-resourced practices, the chief executive of NHS England has said.

In a speech to delegates at the Royal College of General Practitioners’ conference in Liverpool on 3 October, Simon Stevens said that areas where practices were struggling to recruit doctors or to expand their premises to offer more services could benefit from coming under the umbrella of large NHS foundation hospital trusts. He cited areas such as Northumberland and Newcastle,1 where hospital trusts provide list based general practice services as part of moves to integrate primary and secondary care services.

But Stevens stressed that the model would not be appropriate everywhere, citing the royal college’s preferred federations model—in which GP practices cluster together to provide a wider scope of services—as an equally valid mechanism for revamping primary care. He also suggested a third model where federations expand to include consultants, specialists, community teams, and social care in GP led provider organisations.

He said, “We . . . have a situation where the route for building practice infrastructure and premises may have been fit for purpose in 1948 but in many ways is now not.

“In some parts of the country, perhaps in some inner cities where it is hard to recruit and where the current GP services are struggling, should we for all time persist in the notion that GPs and hospitals can never be in the same organisation? I don’t think we should.

“If we’re serious about integration, we certainly don’t want a takeover by hospitals of general practice, but should we back the arrangements that exist in Northumberland or in Newcastle, [or] one or two others, where a single organisation—the hospital—could also provide list based general practice on the same terms as other GPs? I think to rule that out across the board would be an assertion of ideology over pragmatism.”

Stevens acknowledged some potential risks with this approach, but he added, “When you look at the balance sheets of some of these large foundation trusts, when you think about the need for premises investment and other investment to provide the kind of expanded services we want, it is ridiculous that in some of the most ill served areas of the country for primary care we’ve got this [secondary care capacity] sitting there and it’s not being put to work to build primary care capacity.”

But he said that well developed GP federations could fulfil a similar function, if they looked beyond simply being general practice organisations.

“In some places, as these larger federations of GP providers take shape, there is no reason why they should just be confined to general practice,” he said. “I think it is perfectly possible to envisage them becoming multi-specialty provider groups including incorporating consultants, perhaps some of the medical specialties [such as] geriatrics, psychiatry, possibly even social care services, therapies, nurses.

“There are models beginning to bubble up like this, not at scale in most places. There’s no reason when that happens why you couldn’t also imagine these larger primary care groups taking over local parts of the health service, including community hospitals.”

In his speech, which received a mixed response from the assembled GPs, Stevens set out four other suggestions for “future proofing” general practice, alongside his proposals for new models of integration. These were to stabilise and review current funding; to give clinical commissioning groups more power by allowing them to commission primary care; to tackle workforce problems by recruiting and retaining more GPs; and to communicate more effectively to patients and the public what the NHS can and cannot deliver.

In response, Maureen Baker, chair of the RCGP, said, “This could be the beginning of a ‘new deal’ for general practice as long as it is backed up by major investment to make it a reality. Simon Stevens has shown today that he recognises the shocking crises in investment, workforce, and premises engulfing general practice, whilst acknowledging the need for new models of care and greater patient involvement.”

She added, “The pressures now affecting general practice are so severe that we hope NHS England will consider taking radical measures in the event of extreme pressures this winter, including suspending the QOF [Quality and Outcomes Framework] to ensure that GPs can look after patients rather than being overwhelmed with ticking boxes.”


Cite this as: BMJ 2014;349:g6055


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