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Majority of GPs should be contracted by hospital trusts, says Javid-backed report

by Caitlin Tilley
4 March 2022

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The health secretary has welcomed a report that recommends phasing out the GMS contract by 2030, with the majority of GPs contracted by scaled providers such as hospital trusts.

The report by think tank Policy Exchange today also recommended a £6bn ‘rescue package’ for general practice to steadily ‘buy-out the GP owned estate’.

In a foreword to the report, the health secretary said that it ‘offers some credible ideas and insights’.

He added that primary care has an ‘exciting future’ but that the Government needs ‘to think deeply about how services are designed’.

It comes as Pulse revealed yesterday that Government officials have visited Royal Wolverhampton NHS Trust’s salaried GP model to explore ‘alternative ways to deliver primary care’.

The report recommended that there must be ‘a commitment to phase out the GMS contract by the end of the decade’, to be replaced by ‘a series of one-year top-up contracts until its eventual phase-out by the mid-2030s’.

It added that incentives between primary and secondary care should be matched up, and ‘GPs should become predominantly salaried and contracted by scaled providers (trusts, provider collaboratives, or large-scale primary care operators)’.

The report said: ‘This is not a nationalising of general practice: independent provision will continue to play a central role across primary care, but with incentives to work at a greater scale and with reformed approaches to contracting and reimbursement.’

Policy Exchange advised that general practice should move to an ‘at-scale model with specific elements delivered through “layers of scale”’, with workforce planning and lease responsibility at ICS or ‘scaled primary care provider’ level.

In his foreword, Sajid Javid said: ‘There is an exciting future for primary care and we need to think deeply about how services are designed and planned – not just within general practice, but across pharmacy and dentistry too.

‘To provide a 21st-century offer to patients, we must give the front-line innovators the right tools to evolve to meet the needs of patients in the future.’

He added: ‘This Policy Exchange report offers some credible ideas and insights – across digital transformation, workforce, and personalising care provision. I welcome the report as a pragmatic contribution to this vital debate on the future of the NHS.’

Mr Javid added that during his tour of the country, ‘a consistent message [he] heard from the public was the frustration they experience when accessing their GP’. 

The report said GPs have ‘never been more important’, but that ‘the current model is neither adequately staffed, nor optimally planned’.

It also recommended the introduction of ‘real-time, open-access “Trip-Advisor style” patient reviews’ of GP practices.

This comes after the Government and NHS England’s controversial October GP access plan set out that patients will rate GP practices in ‘real time’ via text message, with results to be published this year.

Other policy recommendations made by the report included:

  • Clear guidelines defining ‘demand pressure’ so GPs can report to LMCs ‘against a national baseline’;
  • A support package to keep GP partners in post, alongside offering ‘full employment’ for current partners;
  • NHS England and the Government using technology to address GP shortages in impoverished areas;
  • Looking at ways for NHS-trained GPs to give sessions online from abroad;
  • A strategy between NHS England, the Government, the BMA and RCGP to make general practice an attractive career to medical students;
  • Changes to PCNs in the new five-year framework, with increased ARRS funding;
  • A Government-commissioned ‘review of reimbursement frameworks in primary care’;
  • Digital-first general practice wherever possible, but with more emphasis on ‘service quality’ when commissioning digital healthcare;
  • Improvements to the NHS App and the introduction of ‘first contact primary care navigation programme’;
  • A Digital Health and Care Act in Parliament;
  • ‘Hubs’ to ‘upskill the workforce’ and reduce ‘digital divide’ in communities, commissioned by ICSs.

Responding to the report, RCGP chair Professor Martin Marshall said the College ‘agrees’ that a ‘comprehensive rescue package is urgently needed for general practice’.

However, he added: ‘We would advise caution against implementing wholescale changes to the way GP care and services are delivered and how patients access them, without properly piloting and evaluating such initiatives in terms of efficiency, patient safety and how they impact on the long-standing trusted relationships between family doctors and their patients.

‘We would also urge policymakers to recognise that current models of NHS general practice – including the partnership model – delivers exceptional benefits for the NHS.’

A report from The Times in January that Sajid Javid is planning a review of primary care, which could see GPs incentivised to join up with trusts in a model like that in Wolverhampton.

Under Wolverhampton’s integrated model – known as ‘vertical integration’ – nine GP practices subcontract their GMS contracts to the trust.

This story way published on our sister title, Pulse.