19.02.14
New GP contract could bring care closer to home
Family care networks should provide a wider range of services for patients outside of hospitals, a new report from The King’s Fund has argued.
The report suggests that networks of GPs would strengthen their role as providers and coordinators of care in collaboration with other staff working in the community.
The King’s Fund proposes a new GP contract, to sit alongside existing arrangements, which would require practices to link up with others to work at scale, with a focus on outcomes not on how they are delivered. This will bring together funding for general practice with funding for other services in a defined population to encourage innovation and offer a wider range of services, including out of hours care.
The new contract would require effective governance measures to deal with any conflict of interests, a range of capabilities to manage the contract successfully and “sophisticated” means for contracting and incentivising with their networks.
At least five years would also be required to assess the benefits of the approach, the report added.
Chris Ham, chief executive at The King’s Fund and one of the report’s authors, said: “This new funding and commissioning model for primary care could offer GPs an important opportunity to lead the way in finding new and innovative ways of working.
“At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring money into general practice if GPs take responsibility for providing and co-ordinating a wider range of services. GPs are well placed to do this because of the registered lists of patients, but it would also be possible for trusts providing hospital and community-based services to take on the leadership role, working with GPs as partners.”
Rachael Addicott, senior fellow at The King’s Fund and the report’s lead author added:
“Our research with GP practices that are already starting to work in this way showed that to improve the quality of patient care you needed to ‘win over the hearts and minds’ of GPs and local providers. A significant investment in people and in leadership and organisational development is a must if the new family care networks are to have the capabilities they need to succeed.”
Dr Michael Dixon, chair, NHS Alliance said: “The NHS Alliance fully supports the King’s Fund’s new report Commissioning and funding general practice: making the case for family care network, as it is an issue that we are also highly passionate about. We believe that it’s important for general practice to take the initiative and lead on developing care within the community, while ensuring that they still offer the same level of personalised, high quality care.
“The direction suggested by the King’s Fund, is very much the direction we have also espoused, but the system militates against it in so many ways, and we need to overcome this. The real issue is how do we keep the small is beautiful aspect of GP – the relationships with the patients and personalised care – while also enabling it to work at scale to provide services outside hospital, and become a serious influencer of local health.
“Over the coming year, the NHS Alliance will look to work with the general practices around the issue of federation, and help them to overcome any barriers they may face along the way.”
Anne Longfield, chief executive of national charity 4Children commented: “Recognition of the need for a rapid and radical shift in the current model of general practice to a more partnership based approach in order to bring about a more effective, integrated service is welcome. However, we believe that to truly put the needs of the family first there must also be wider collaboration between local health services and children and family services and support.
“Parents tell us that they struggle to find the holistic health support or treatment they need, which means that children continue to have the symptoms of poor health treated, rather than the root causes. In order to turn around our late intervention culture to one which focuses on prevention rather than cure, we need to see GPs and health professionals pooling funding and creating strong partnerships beyond the health community. Only by working alongside those services which provide both universal and targeted support to families across a broad range of issues, such as Children’s Centres, Troubled Families Programmes and social services, can we prevent health problems escalating and offer families the kind of joined up help they need.”
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