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A beginners guide to GP Networks

Background


The NHS is at a critical juncture in its evolution.  


It is expected that the NHS will have a funding deficit of £30 billion by 2020.  Services need to change develop to meet the growing needs of our aging, more complex population despite this tightening financial envelope.  It is widely recognised that the NHS cannot continue in its current state and so we are forced to consider alternative models of care.  Staying as we are is no longer considered an option.  Irrespective of which way the political wind blows, it is now seen as inevitable that health and social care commissioners and providers will collaborate and eventually integrate to deliver joint health and social care.


In recognising this, the 5 year forward view (5VFV) document was created in 2014 and several new models of care were described to help dissolve the traditional boundaries between health and social care services.   Pilot sites known as Vanguard sites grew from this and are currently operating to test the various new models of care.  It is hoped that a small number of these sites will be shown to be effective and efficient in delivering integrated health and social care, and will therefore provide template models that can be rolled out across England to help address the problems currently faced by the NHS.  A number of these sites will fail, and a number will be successful.


Whilst the 5YFV is a professional document backup up by policy and research, it requires the dedication of grass roots clinicians to make it a reality - clinicians who are already busy providing care for patients on a day to day basis and who struggle to make time to be part of large developing and sometimes experimental organisations.  For this reason, the BMA, RCGP and LMCs have been working hard to convince NHS England and CCGs to free up resources to support front line clinicians to have have the time and capability to work toward the development of these new networks.


NHS Doncaster CCG are now in a position to provide resources to clinicians to be part of this development locally.




Where are we now?































Doncaster is currently a collection of 43 GP practices of varying size and capability.  NHS England hold our “core” contracts and soon, NHS Doncaster CCG will have the delegated responsibility of managing these contracts.  We operate largely independently of each other and, on the whole, do not co-ordinate our efforts in terms of delivering health and social care.  Of course, there are small scale examples of where practices do deliver services together.  Large scale providers hold many pan-Doncaster contracts and deliver those services to us (such as “Rdash” and District Nurses), or sub contract the service to us so that we can help deliver the services (such as “TriHealth” and contraceptive services).



Where is this all heading?

The current idea is that we will develop accountable care organisations (ACO) who have joint commissioning and providing responsibilities for a population with a pooled resource.  Whilst this model of a healthcare system is still some way off in Doncaster, things are starting to develop at pace.  These organisations will be developed to dissolve the artificial boundaries between provider organisations and ensure a smooth patient journey across services.  Given that the ACO has a pooled resource allocation it is expected that the organisation will be efficient with reduced bureaucracy and lead to a reduction in fighting for resources as the budget is fixed across the healthcare market.


There are many questions left unanswered about ACOs including what form it will take, who will run it and how will it engage with clinicians (i.e. will we become employed?).  The Vanguards sites are expected to help answer at least some of these questions, but the reality is that ACOs are so new, no one yet has the answers.  An example of how an ACO might look is below.  In this example, the ACO is an amalgamation of Doncaster GP practices and DRI as well as enveloping some of the NHS Doncaster CCG commissioning functions.  There are a number of variations of how this might look.



























How do we get there?

This is up to front line clinicians and is very complex with risks and opportunities along the way.  Again, because this is all so new, no one yet has the “right answers”.  There are a myriad of options.


In theory, the evolution of an ACO might look something like

this…


For the purpose of this guide, we will discuss MCPs rather than

PACS (primary and acute care systems).  The pros and cons of

each model are the thoughts of Doncaster LMC and are by no

means exhaustive.  This is a beginner’s guide, after all.
















What is an MCP?

An MCP is a multispeciality community provider where practices group together to form networks or federations to offer a broader ranger of services through a wider range of health care professions (such as pharmacists, counsellors, physiotherapists or secondary care clinicians).  The MCP is a varied entity and can be broken down for ease into three different types;


  1. Soft MCP - A straightforward development of where we are now.  Providers naturally come together in networks of like minded groups of population sizes around 30,000 - 50,000.

































Pros


Cons





  1. Directed MCP - a purposeful and structured coordination of practice networking to ensure coordination and carefully managed collaboration.  This is usually “directed” by commissioners and can be encouraged through the development of local contracts to meet specific needs.  This model has a suggested population size of at least 100,000.
































Pros


Cons





  1. MCP - provider led collaboration to form a super group to cover large populations.


































Pros


Cons






Concluding thoughts…

Doncaster is at a turning point in the development of primary care.  Each model of care has pros and cons and the choice of how we develop should be governed by how we want to care for our patients given the challenges of the NHS in the coming years.  Some of the options available to us may feel like the NHS is “here again”.  However, it is expected across England that some organisations will fail as a consequence of this development.  In real terms, this means that if we do not choose wisely and invest ourselves in making our development a success, there could be practice closures.  In the event that a practice fails in Doncaster, it is very unlikely that we would see a new GMS or PMS practice.


It is the opinion of Doncaster LMC that we need to choose a care model which is





Useful resources


BMA briefing on GP new models of care


RCGP Federations Toolkit


Original NHS 5 year forward view document


NHS 5 year forward view - New Care Models update (powerpoint presentation)


https://www.england.nhs.uk/ourwork/futurenhs/new-care-models/


New Care Models - examples of current Vanguard sites

 


We must help General Practice to be inclusive, supportive of each other, resist the fragmentation of pathways and above all  - create an environment where primary care can thrive.


Dr Dean Eggitt