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Is Amalgamation of Hospitals and GP Practices the way Forward for Primary Health in the UK?

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The National Health Service is at breaking point, financially and on a supply and demand basis, too. Paraphrasing a certain great Briton:

“Never before have so many patients been served by so few staff with so little money.”

In this article, I want to examine the potential of a new model of primary care provision.

A GP practice model for the future?

In the last few months, I’ve noticed that North Derbyshire CCG has been keen to hand over NHS GP contracts to Chesterfield Royal Hospital FT (Chesterfield Royal). In May, The hospital’s subsidiary Royal Primary Care was handed temporary control of three practices which had run up against a brick wall of financial problems. In August this arrangement was made permanent, with the award of a 15-year contract from the North Derbyshire CCG.

Undoubtedly this is good for patients. It ensures continuity of service and that the three practices aren’t going to join the record number of GP practice closures.

Chesterfield Royal medical director Dr Gail Collins told GP Online: “We are pleased to be able to sustain these services for local people at a time when fewer doctors are choosing to train in primary care medicine and go into partnerships. We need to be able to offer new solutions – and over the past year it is clear that working for the Trust, as part of Royal Primary Care, can be a successful and viable approach.

“Over the last year we have been able to attract and recruit five more GPs, there are early morning, evening and weekend GP appointments and new services have opened – including an ultrasound clinic staffed by the experienced team from Chesterfield Royal Hospital.

“Through this long-term contract we will continue to develop Royal Primary Care, bringing GP, primary care and hospital services together in ways that will benefit all our patients.”

We looked at this type of modelof providing GP services in April. Effectively, Chesterfield Royal is taking on the mantle of being a Multispecialty Community Provider (MCP).

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Is the new model financial or care-based?

Chesterfield Royal has taken on new GPs and practice contracts at a time when those practices could no longer survive independently because of their parlous financial state. However, looking at its latest annual report, Chesterfield Royal has its own financial problems. Its 2015/16 deficit of £2.6 million was almost £5 million below plan. It has increased its borrowings, while at the same time seen its cash and cash equivalent balance decrease by £1.4 million (read its annual report here).

Perhaps a clue as to why it is keen to expand so rapidly into GP practices (it has also opened a partnership with Blue Dykes Surgery, with a view to a permanent arrangement of full control) is to be found within its report where it discusses challenges and risks to its operations.

Its self-declared challenges include:

- Developing sustainable clinical services that deliver improved care in terms of clinical effectiveness, patient safety, and patient experience.

- Ensuring appropriate staffing levels, and being able to recruit and retain key clinical staff to reduce the use of agency and locum staff.

- Delivering the range of services within agreed financial boundaries, whilst supporting the development of the alternative models of care.

- Embedding seven-day services into the culture of the organisation and in the service models being developed as part of our clinical services strategy.

Its self-declared risks are:

- Potential loss of income because of commissioner affordability, reduced activity and service reconfiguration, and contract penalties.

- Under performance on activity plans, leading to reduced funding, which if not contained would have a negative impact on quality.

- Excessive reliance on locums and agency staff, creating significant cost pressure and having a potentially detrimental impact on quality.

Owning GP practices could make sense financially and for quality of care

It could be argued that by owning GP practices, Chesterfield Royal is positioning itself to benefit financially. A few weeks ago I discussed ways in which GP practices could make extra cash from non-core services. Owning GP practices is a potential new revenue stream for Chesterfield Royal. Let’s not forget that the trust already relies heavily on its £1.2 million income from parking charges.

Of course, there is a wedge of extra help and funding for GP practices in the next few years. Undoubtedly, this makes a takeover of GP practices more attractive now, especially by a body that has experience in accessing such funding routes.

And then, of course, there’s the government’s eagerness to move to a seven-day week of doctor care in hospitals. GPs are already prepared for this. Get enough GPs under your belt, base them in hospitals at weekends, and hey presto! Maybe.

How do you see the future of GP practices? Will they be fully integrated into Foundation Trusts? Or will they continue to operate best by being a long arm’s length away?

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If you have any questions or feedback, please do not hesitate to contact me -alex.henman@esuppliesmedical.co.uk- 01865 261451

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