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Would a New Model of Working Suit Your GP Practice?

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As the pressure on GP practices continues to grow – with a growing population, plans for seven day weeks and extended hours, and the scarcity of trainee GPs all combining to create the perfect storm – many are exploring new sustainable operational models. Some GPs have openly declared their belief that the traditional contractor model is defunct, and that specialised care is the inevitable way in the GP practice is evolving.

Indeed, in the NHS England 5-year plan, alternative models for GP practices have been put forward. These include:

- Multispecialty Community Providers (MCPs), which are basically networks of GPs and other healthcare providers that would employ consultants, senior nurses, and other specialists to work alongside community healthcare workers and social workers. Such as set-up would move care out of hospitals.

- Integrated Primary and Acute Care Systems (PACS) allows hospitals to employ GPs, effectively setting up their own GP surgeries, maintain their own patient lists, and integrate directly with other primary care providers.

PACS already on the agenda in several Trusts

In effect, a PACS model moves doctors from the role of independent contractor to employee. Already we’ve seen:

- Yeovil District Hospital Trust advertising for GPs at salaries up to more than £100,000

- Salford Royal Foundation Trust bidding for £200 million government funding to pilot an organisation that will provide primary and secondary care

- LMCs in Cumbria, Devon, and Lancashire expect hospitals to become PAS and employ GPs

These initiatives have been led by hospitals and trusts themselves. However, GPs in Gosport have taken the lead and approached their MCP – the Better Local Care (South Hampshire) Multispecialty Community Provider – to present how a salaried model could work for them. If the MCP model is seen as effective, it is likely to lead to significant reduction in the number of GPs in the town.

The lead GP, Dr Donal Collins, asserts that the model works not by time-clocking but by setting minimum earnings thresholds and keeping GPs invested in the practice. Certainly, among the attractions for GPs is the ‘derisking’ that the salaried model offers: no longer will GPs be responsible for property ownership or leases, for example.

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Pros and cons of the MCP

Certainly there appears to be both advantages and disadvantages of the MCP model.

Current partners of GP practices would lose their ownership and leadership. No longer would they be the bosses. That works both ways – on the one hand it may appeal to be relieved of such responsibility, yet on the other it could be argued that doing so also reduces motivation.

Practices are generally well managed and well run, and this evolution could be a step that confuses spheres of responsibility and puts patients in a similar position. Just when patients are learning to trust their GPs again, the goalposts are moved.

It might also prove to be the case that Trusts wish to specialise rather than generalize, and then where does this leave the patient who has no traditional GP practice available to them? On the other hand, consultant funding is higher than GP funding and so the MCP model may be more financially viable.

And while discussing funding, could the new model give room for abuse of the system with MCP paid GPs encouraged to push private care at far greater value to the MCP (or PAC).

Perhaps of equal concern is the changing role that employment in an MCP would engender. It is inevitable that current GPs would be asked to work to a more specialist bent (for example, the Yeovil District initiative is aimed at providing care for the elderly). This will consequentially cause a loss of the generalist skills for which GPs have worked so hard to attain. Or might this be a good thing? Do patients more appreciate the specialist approach, or do they accept the ‘funneling’ system as we have now (GP through to specialist)?

As a GP, would you welcome the possibility of earning a salary without the need to have one eye constantly on costs? Would this allow you to concentrate on provision of care rather than balancing the books? And how does the CQC and its inspections fit into this jigsaw? There are plenty of questions to be answered, but, like the Brexit issue, very few facts are forthcoming. The future, however well-planned, remains unpredictable.

Let us know what you think. We’d be delighted to discover more about how our clients view the future.

Further information:

BMA:New Care Models - Vanguard Sites

New Care Models Briefing Paper

THE FORWARD VIEW INTO ACTION: Registering interest to join the new models of careprogramme

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