LMC CEO Briefing (Part 1) Are traditional GP partnerships at risk?

As colleagues review the content of the NHS 10-Year Plan colleagues are asking “Are traditional GP partnerships at risk?”

There is little mention about general practice within the 10 Year Plan. The focus of the Plan is on neighbourhood working and the development of services at the neighbourhood scale. With this focus on different size populations, it could be interpreted as indicating that smaller traditional practices may not fit within this new model.

The Plan states:

‘Where the traditional GP partnership model is working well it should continue, but we will also create an alternative for GPs. We will encourage GPs to work over larger geographies by leading new neighbourhood providers.’

This message has been reiterated by Wes Streeting MP (Secretary of State for Health and Social Care) and by Dr Amanda Doyle (National Director for Primary Care, NHS England).

The message is therefore clear that there is no stated intention to replace the existing GP partnership model but there is an inherent threat to those practices who are deemed to be failing or to not have ‘stepped up’.

The Plan foresees three options for practices which will be determined based on the size of the practice and the model in which they wish to provide services across their neighbourhood.

Traditional model

Single Neighbourhood Provider (50k population)

Multi-Neighbourhood Provider (250k plus population)

The traditional GP model

The current model of GP provision through existing core contracts (GMS, PMS or APMS) will remain the default model for all practices for the foreseeable future. The General Practitioners Committee (“GPC”) and the government will be commencing negotiations for what Mr Streeting has referred to as ‘a new substantive GP contract within this Parliament, without preconditions, based on collaborative work, and in the spirit of mutual trust and good will’. This is unlikely to take effect until 2027 or 2028.

There have been concerns raised by the GPC and by LMCs that there was no reference to these negotiations within the Plan. It may be possible that the new contractual structures, outlined below, will be introduced and in some areas implemented before these negotiations have been completed. It may also be possible that the government did not want to pre-empt the negotiations by making any presumptions within the Plan. Current contractors may be in a situation in which it will be commercially preferrable to defer making major contractual decisions until they know what all their options are. This could be a limiting factor for the adoption of the new models until the negotiations have been completed. This would further support the notion that traditional models will be the prominent model until 2028, but it is essential that this does not create complacency. The failure to participate and support the development of the Neighbourhood Health Service could place contracts at risk before the new contracts are published.

The role and focus of general practice are likely to change. Where they fit within the ‘neighbourhood’ will need to be clearly defined and there is a risk that they may be required to change how they operate to fit the requirements of the neighbourhood if they do not take a proactive role in shaping this. There could be a risk to existing enhanced services which could be redesigned to be delivered across a larger geographic scale. Whilst many practices are likely to remain the provider of choice for this work it is not guaranteed. This is particularly important where the Multi Neighbourhood Providers are established and/or where Foundations Trusts are given control over the whole health budget, effectively giving them increased power over how and where funding is spent.

There are some essential steps practices should consider securing their role and functions by:

Continuing to build collaborative services and to integrate with your neighbouring practices

Taking a proactive lead in identifying and defining the needs of your neighbourhood

Creating relationships and contacts with other providers including other primary care services, community services, social services and third sector providers

Practices will continue to have one of the strongest relationships with the patients and this connects them to their communities. Building this strength will ensure that the practices continue to have a key function whilst working at a small scale of the population.

This will not however be achieved alone and working with other practices in your PCN and within neighbouring PCNs will be essential.

 The future of traditional GP practices

For how little general practice is referenced within the 10 Year Plan the impact it will have on the future of practices is likely to be the most hotly contested. This is a very political debate as evidenced by the responses from key individuals and organisations within the sector.

However, what is clear is that there will not be an immediate change. Traditional GP partnerships running their local practices will be the standard model for delivery. For some these changes will offer a new opportunity to change how they deliver services, and for others there may be limited evidence of any immediate change. Ultimately though all practices will be impacted by the implementation of these plans. To prepare for this the practices must stay engaged with the system, work collaboratively with their PCN member practices, ensure they have a high standard of service delivery, maintain high quality standards, and have strong governance. These will place the practices in a secure position ready for when the changes start to take effect.

What is of concern is that practices and organisations are being rushed, by the August deadline, to ‘sign up’ to pilots without any real understanding of the detail (which has not been published yet).

William Greenwood

Chief Executive