GP leaders have voiced concerns over potential plans to divert enhanced services funding away from GP practices to fund new neighbourhood contracts.
The plans were alluded to by BMA GP Committee (GPC) chair Dr Katie Bramall at the England LMC conference last week. In her opening speech, Dr Bramall said the Government planned to ‘bundle up’ the funding to ‘subsidise’ the neighbourhood model.
This is understood to come from a senior source as a plan being considered by the Government.
Addressing the Manchester conference, Dr Bramall said: ‘There was one mad rumour floating around Labour Party Conference that might just be true, that you’re going to gather together the shed load of money spent on locally commissioned services, bundle it up nationwide and that can help subsidise them.’
Health secretary Wes Streeting seemed to back this up, when he stated that the single neighbourhood provider contract will be ‘for the delivery of enhanced services’.
In a speech to the NHS Providers conference on Wednesday, Mr Streeting hailed the new provider contracts as ‘taking the best of the NHS to the rest of the NHS’.
He mentioned ‘a single neighbourhood provider contract for the delivery of enhanced services, for patients, through expert, multi-disciplinary teams, and a multi-neighbourhood provider contract to lead the Neighbourhood Health Service at scale.
‘Pooling resources and expertise will deliver better services over larger areas, like frailty or end-of-life care, and deliver a more efficient back office so more of GPs’ time is spent with patients’, Mr Streeting said.
Clinical director of Coventry North PCN, West Midlands, Dr Matt Baines, said it is a concern and that he is planning for 'different scenarios'.
'Over the past few years, we’ve worked hard to integrate ARRS roles into our PCN, and they’ve become a vital part of how we support our practices.
'These roles are helping us manage patient flow more effectively and improve the way we deliver care — particularly around access and long-term condition management.
'At this stage, it’s difficult to know exactly how things will unfold, and we’re hopeful that the ARRS funding and staff will remain. That said, we’re aware of the need to plan for different scenarios and ensure we’re in a position to adapt if the funding landscape shifts,' he told Pulse PCN.
These concerns follow on from the NHS 10-year health plan, published in July, which promised to roll out the two new contracts ‘beginning next year’, including ‘‘single neighbourhood providers’ that deliver enhanced services for groups with similar needs over a single neighbourhood’.
Specialist medical accountant Andy Pow told sister title Pulse that shifting resources from GPs could ‘destabilise practices’ without core funding increasing.
He said: ‘Funding from enhanced services including the PCN DES provide significant resource to GP practices. Any decision to move practice based resource to neighbourhoods would have the potential to destabilise practices unless other core funding was increased.
‘Any move would need to be done in conjunction with a fully renegotiated core contract. Failure to do that could be a major risk to the current structure of general practice.’
Dr Brian McGregor, medical secretary for YORLMC based in Harrogate, North Yorkshire, said: ‘We spent a lot of time and energy in Humber and North Yorkshire last year negotiating new enhanced services and an agreement that took a long time to reach and got signed up by every practice and support from not just ourselves but Humberside LMCs.
‘Having put 18 months of investment in making those agreements, it would be extremely disappointing if a national directive was to disrupt that local relationship.’
Dr McGregor said: ‘All funding streams are currently supporting delivery for general practice, and if they were to disrupt any of those funding streams, there is no doubt it would have a knock-on effect on the delivery of services.
‘It wouldn’t just be the enhanced services, because it would threaten the delivery of other services as well, staffing based on the current volume delivery and if you reduce the volume by taking the enhanced services away, you wouldn’t need the same amount of staffing.’
Despite Mr Streeting anticipating ‘a real role for GP leadership’ in the neighbourhood models, Dr McGregor expressed doubt over GPs’ willingness to take them on.
‘I don’t see GPs queuing up to run these services. Since 1 October, and the changes then, GPs are busier than they’ve ever been, and there isn’t the headspace or the capacity to deal with producing or managing a new service’, he said.
‘If you’re going to take these services out of general practice, how do you introduce another layer of management, another layer of service provision, without there being additional bureaucratic cost.’
Referencing plans for NHS England to make around 18,000 administrative posts – 50% of all its staff – redundant, Dr McGregor said: ‘They (the Government) are just in the process of spending a billion pounds making further level of bureaucracy redundant … and yet they want to introduce a further layer of bureaucracy that will have cost involved.
‘They want to introduce another layer of management and current costs, which means something has to reduce to create the funding for that management. What will reduce is service provision – it’s the patients that will suffer.’
In the same NHS Providers speech, Mr Streeting also said there was ‘no reason’ GPs could not lead newly-announced Integrated Health Organisations (IHOs), despite announcing ‘advanced foundation trusts’ would be the first to take on the new contracts from next year.
A version of this story first appeared in sister title Pulse.