The NHS Long Term Plan: A primary care snapshot

The Plan envisions a shift away from hospital based care towards community settings – multidisciplinary primary care networks. Supporting the integration of primary and community care will be an additional £4.5bn funding by 2023/24. And this is a base level of funding that clinical commissioning groups and integrated care systems are likely to supplement further. This funding is designed to address demand pressures, workforce expansion and new services.

New service models in the shape of primary care networks have a central role in the delivery of the Long Term Plan.

GP practices will be expected to join primary care networks that work together covering 30-50,000 patients. But, what does this mean in practice? As part of a set of multi-year contract changes individual practices in a local area will enter into a “network contract” and agree shared objectives, as an extension of their current contracts (GMS, PMS or APMS). Most CCGs have local contracts for enhanced services and these will normally be added to the network contract rather than deal with individual practices. GP practices in any given primary care network will have a “designated single fund” through which all funding and resources will flow, according to the Plan. This funding will be paid to one nominated constituent practice on behalf of the network as a whole. 

The beneficial aspect of these networks is the fact that GP contractors are being asked to integrate in a ‘bottom up’ manner.

The funding and contractual changes aside, arguably the most beneficial aspect of these networks is the fact that GP contractors are being asked to integrate in a ‘bottom up’ manner. As such, and in order to realise positive outcomes in their specific locality, each primary care network has the ability to consider the disciplines that could be added to their particular network and the changes that could be made when it comes to service delivery. Indeed, while the engagement of advanced nurse practitioners, pharmacists or musculoskeletal therapists are all disciplines that the subsequent GP Partnership Review highlighted as being additions that could deliver real change, it would be for the individual networks to decide what changes will have the most significant impact for them.

Despite this, it would be naive not to think that there is a long term ambition when it comes to primary care networks. The Long Term Plan does indicate an ultimate vision where a typical neighbourhood team will include a range of health professionals from GPs, pharmacists, community geriatricians and other Allied Health Professionals such as chiropodists and physiotherapists joined by social care and voluntary care. District nursing is already configured on network footprints and this will become the required norm.

GP Quality and Outcomes Framework will undergo “significant changes”.

To support this new model, the GP Quality and Outcomes Framework will undergo “significant changes” to include a new Quality Improvement element which is being developed jointly by the Royal College of GPs, NICE and the Health Foundation. The aim is to abandon the “least effective” indicators with a focus on more personalised care.

And there are financial incentives for primary care networks: there will be a new “shared savings” scheme sharing any saving from reductions in avoidable A&E attendances, admissions and delayed discharge, streamlining patient pathways to reduce avoidable outpatient visits and over-medication through pharmacist review.

As part of the Plan’s ambition to deliver “fully integrated community based healthcare”, the Enhanced Health in Care Homes vanguards will be rolled out over the next decade with support from primary care networks providing care home residents with a named GP and receive regular clinical pharmacist-led medicine reviews.

Integrated care systems will be “central to the delivery of the long-term plan”.

The whole of England is to be covered by ICSs in two years – by April 2021, growing out of the current network of 44 Sustainability and Transformation Partnerships. With an increased focus on population health, ICSs will have a key role in working with Local Authorities at “place” level and through ICSs, “commissioners will make shared decisions with providers on how to use resources, design services and improve population health (other than for a limited number of decisions that commissioners will need to continue to make independently, for example in relation to procurement and contract award)”.

Every ICS will need streamlined commissioning arrangements to enable a single set of commissioning decisions at system level. Typically each ICS area will work with a single CCG. The implication is that “CCGs will become leaner, more strategic organisations that support providers” on population health, service redesign and Long Term Plan implementation.

Every ICS will also have “full engagement with primary care”, including through a named accountable Clinical Director of each primary care network.

Digital care

While technology is a key feature throughout the Long Term Plan, arguably the most significant aspect of the Plan when it comes to primary care is the proposed creation of a digital GP provider. The aim is that over the next five years patients will have a choice. They will either be able to see their GPs in their own practices or see a new digital GP provider. In order for this to become a reality, there is a recognition within the Long Term Plan that there needs to be a review of the current out-of-area arrangements alongside a review of the GP payment formulae (the latter is required to “ensure fair funding without inequitably favouring one type of GP provider over another”). Despite this, there is a very real danger of substantial conflict unless a sensible model is created which sees primary care contractors having the ability to offer both face-to-face and digital services to their registered lists. The preference has to be to develop digital services so they are integrated within one practice or group of practices,serving a registered list, as opposed to being standalone providers themselves.

Primary Care Initiative

As one of the market leaders in the field of health and care, we are proud to have launched our Primary Care Initiative. This initiative brings together and develops the expertise within our dedicated health care team to ensure that they remain best placed to help those working within the evolving primary care sector.

Given the evolution of primary care, the initiative has two key aims:

(i) to ensure that our clients have access to the full range of legal services required to support them in connection with the myriad and evolving legal issues they face in operating their businesses; and

(ii) to ensure that our clients are kept abreast of the latest developments in the primary care sector.  

With this in mind, look out for the series of events and updates that we will be running throughout 2019.

Primary care seminar: General Practice – Legal and Accountancy update 2019

Understanding pressures in general practice and what lies behind this? We have seen the release of both the NHS Long Term Plan and the GP Partnership Review. These, alongside the expected outcomes of the GP Premises Review, are placing general practice in the spot light. But are we being told anything new? Are they providing any comfort when it comes to addressing those recurring issues that affect GP contractors and the premises they occupy? Irrespective of the outcomes of these recent and expected releases, what practical steps can be taken to address these recurring issues?

This is the first of a number of events we will be running in 2019. It is a free training session delivered by Mills & Reeve and Larking Gowen. If you would like to register for this event on Tuesday 26 February 2019 at 9:30 am in Norwich, click here.

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