John Copps looks at the impact of the re-organisation of primary care on GP partnerships and how they will have to change. This article was prompted by a round table event on Primary Care Networks held by Mutual Ventures at the end of November. Thank you to the participants for their contributions to the discussion.
Primary care – the front-line of the NHS – is arguably undergoing its biggest change since 1945. For the first time in NHS history, funding for primary and community care will grow faster than the overall budget during the next ten years. This reflects a desire to shift focus away from hospitals, prioritise prevention and move care closer to patients’ homes.
As new ways of organising services emerge, is the traditional GP partnership model still fit for purpose? And how will it need to adapt?
A move to Primary Care Networks
Top-down impetus for change is coming from the obligation to establish ‘Primary Care Networks’, or ‘PCNs’. These are groups of GPs surgeries serving populations of 30,000-50,000.
PCNs are expected to deliver against agreed national standards, with funding flowing via a revised GP contract with strings attached. To deliver against these standards, NHS England will reimburse costs of five new roles (clinical pharmacists, social prescribers, physician associates, physiotherapists and community paramedics). Of these, only the social prescriber will be fully refunded – so GPs will need to find the extra elsewhere in their allocation. As one GP grumbled to me, this amounts to the government writing GPs a prescription defining how local care should be provided.
What does this mean for GPs?
Part of the purpose of Primary Care Networks is to force GPs to think differently.
Most obviously, PCNs imply a wide definition of primary care. By paying for new roles, they challenge the view of primary care as a synonymous with General Practice.
Linked to this, they encourage GPs to rethink their place as the first port of call for patients. The new paramedic, pharmacist and physiotherapist roles are described in NHS England guidance as ‘first contact’. Judicious use of these specialist clinical roles could help take pressure off GPs.
A consequence of employing additional staff, and potentially expanding premises, is an increased liability for GPs that take the lead on PCNs. As most GP Partnerships operate as unincorporated companies, partners hold the risk for the success or failure of their enterprise, including all debts and contractual obligations. Of course, new funding means that this may be balanced by a greater potential upside, but that it something individual partnerships will need to consider.
Do PCNs fit with the traditional GP Partnership model?
Despite the challenge PCNs pose to primary care, I think they do little to challenge the underlying model of GP partnerships. Whilst the implications of the new funding and roles need to be worked out, as one GP recently told me, it will work well for ‘happy practices’.
But the emergence of PCNs needs to be set alongside a series of other challenges faced by General Practice. Official statistics on the number of GPs point to a crisis in recruitment at a time when demand is soaring. Almost every doctor will tell you that their surgeries are busier than ever, workloads are mounting, and there are not enough hours in the day to see all patients.
Added to this, a new generation of GPs are entering the profession with different expectations to their predecessors. Surveys show that they want to combine General Practice with a portfolio of other clinical work, and that they are turned off by the administrative demands of being a partner. On the ground, retiring GPs partners are finding it harder and harder to find a successor.
What is the future model of Primary Care?
GPs will remain at the centre of primary care but PCNs should pave the way for more patients spending time with other clinicians in the community. It seems likely there will be variation between areas as PCNs all interpret their roles differently.
The GP Partnership model is here to stay – at least for the foreseeable future – and must adapt. But there is also room for new models and different types of organisation providing primary care. This will be less in response to PCNs and more to meet the demands of the workforce and the increasing number of GPs saying that they don’t want to become partners and take on all the liabilities associated with that.
Already there are examples such as Granta Medical Practices in Cambridgeshire, a group of practices moving into a limited liability company with shares held by an Employee Ownership Trust, and Symphony Healthcare Services, a wholly-owned subsidiary of Yeovil District Hospital NHS Foundation Trust.
The NHS must continue to evolve as patient needs change. It is time that primary care recaptured its role as beating heart of the system. To do that it needs old and new models that are up to that job.
For more on our work in the NHS and to hear about how we could help your organisation, contact john@mutualventures.co.uk.