A new vision of primary care with ‘far fewer groups of GP practices’ and 250,000-patient lists has been put forward by Tony Blair’s think tank.
The Tony Blair Institute (TBI) also urged the Government to implement a ‘digital health record’ for every citizen, which would replace the GP record, by 2029.
The think tank has put forward its suggestion to Lord Darzi’s review into the NHS, which is currently gathering evidence, in order to report next month, and will inform a new 10-year strategy.
On the state of primary care, the TBI report said that the ‘traditional model of ten minutes with a doctor to discuss one problem by the time you’re already sick’ is still the norm in some places, but practices are ‘increasingly’ adopting a population health management approach.
It argued that ‘commissioning primary care at greater scale would propel this trend’, noting that some federations already look after ‘far greater numbers’ than the standard PCN size, which is between 30,000 and 50,000 patients.
The report continued: ‘We recommend that NHS England considers a new contracting mechanism for primary care that is outcomes-based, commissions for scale (populations of 250,000 patients) and has a gain-share component.
‘This would see groups of practices benefiting financially from better outcomes and lower rates of hospital admissions; it would also facilitate the movement of funds from secondary to primary care over time.’
Tony Blair’s researchers highlighted that this ‘would not be mandatory’ and would ‘run in parallel’ with the GMS contract – but practices should be ‘incentivised’ to join larger groups, by offering perks ‘on condition of meeting outcomes-based targets’.
‘In time the primary-care landscape would change to one with far fewer groups of primary-care practices – and meaningful choice for patients over which group they register with,’ the report added.
On the digital health record, the TBI said it would be the ‘single source of truth’ for all health and care data, which ‘currently sit in silos across hospitals, GP practices, pharmacies and phones’.
In order to facilitate its creation, the think tank recommended that legislation is changed to make the health secretary ‘joint data controller with GPs’.
This new record would bring together patient data from all NHS organisations as well as private providers and would support the ‘development, adoption and spread of AI technologies in the NHS’.
The TBI researchers said the digital health record would have the ‘most impact in primary care’, by becoming an ‘AI doctor’ for patients, while helping to advance the Fuller stocktake.
They recommended that the Government introduce legislation to ‘compel’ all suppliers of electronic health records to be interoperable. This digital record would ‘help the NHS prepare for the AI era’ since AI is ‘trained and deployed’ on health data.
However, RCGP chair Kamila Hawthorne said that although AI had the ‘potential’ to address unnecessary bureaucracy and administrative processes, it ‘must not be seen as a panacea for all the challenges facing general practice’.
She said any technology-driven solutions must be delivered alongside wider workforce and funding commitments in general practice.
Prof Hawthorne also said that a centralised and shared health record would, in principle, be good for patients and those working in the NHS, but it should not be at the cost of patient data security.
‘We have seen with previous initiatives to make better use of patient data that implementation is highly complex.
‘Such an initiative would need to be developed with appropriate safeguards in place to reassure both patients and GPs that the system is secure and that data would only be used appropriately and with consent. At present, we don’t have that reassurance,’ she said.
The Tony Blair Institute also said NHS England needs to ‘gain greater control’ over GP IT management systems, which are currently commissioned independently by each practice. According to the report, GPs ‘lack the contractual levers to demand change’ of the two dominant suppliers – EMIS and SystmOne.
When building the digital health record, the think tank urged the Government to either ‘procure an entirely new practice-management system for general practice or work with an existing one to build out the tech stack’.
The report comes after Wes Streeting has welcomed back some key Blair-era figures to advise on NHS policy. In addition to Lord Darzi, this includes Paul Corrigan, who will help with the new 10-year strategy, and former health secretary Alan Milburn, who spearheaded increased private involvement in the NHS.
Other recommendations
- The NHS should invest in development of a national AI-powered health analytics platform to ‘drive clinical decision-making’ for doctors;
-
- This would be trained using anonymised data from the digital health record (DHR);
- Over time, the platform would become a ‘personal digital health assistant’ or ‘AI doctor’ which could help with managing long-term conditions or triage when patients are unwell.
- It could be incorporated into GP management systems
- The DHR would allow GPs to monitor risk of patients with long-term conditions and only see them when clinically necessary.
- It would also allow patients to choose services – even the private sector – while preserving continuity with GPs.
- The DHR would ‘allow patients to propel themselves through the referral, investigation and consultation process without constant back and forth with their GP.’
- It would help with managing same-day care needs as patients ‘could be more effectively navigated to the right service first time’.
Source: TBI
A version of this story first appeared on our sister title Pulse.
