Ben was CEO of Nene CCG for 8 yrs. He was a Director of an acute trust and has run national improvement programmes. He is a founding director and Principal Consultant of Ockham Healthcare, which he describes as ‘a platform for change’.
The development of general practice as a provider of an extended range of services is welcomed by some and resisted by others. The main barrier is the concern that some GPs have that any change will mean a requirement for them to specialise in some way.
It is helpful to consider the development of general practice into new service delivery areas separately to the development of general practice as the provider of core GMS/PMS services. It is helpful because the development needs of each are different, because delivering new services is an optional not a necessary development, but primarily because it reduces resistance by clarifying the freedom that any GP has to continue to concentrate on the delivery of core general practice.
CCGs that are serious about whole system transformation require general practice to develop in ways that enable provision outside of hospitals to be radically changed.
So how might this development take place? What stages might this consist of? A route map at this point for those who are keen but don’t know how would be very helpful. So here is an attempt to outline three key steps for the development of general practice provision.
1. Practices form provider organisations. The first step is the development of the basic infrastructure. The current unit of general practice is too small to deliver an extended range of services at any sort of scale. Practices need to find partners that they can work with. This will primarily be other practices, but it could be a whole range of partners including other NHS organisations or even private providers.
Part of what is needed at this stage is investment. This is required to set up governance structures, invest in any necessary capital, and to develop expertise in areas such as business case development. This investment can come from the practices themselves, or can be part of any new partnership that the practices enter into.
Initially these new provider organisations can hold a standard NHS contract for out of hospital services. CCGs can help by consolidating the various LES’s into a single contract, which practices can then choose to deliver collectively through the new provider organisation.
2. Provider organisations offer an extended range of services. The second step is for these new organisations to develop their service offering by incorporating new areas and skills, such as extending into the delivery of community services and building Consultants into their service offering. Again this could be in partnership with other NHS organisations or by offering these services directly.
At this point these provider organisations can start to demonstrate the value they can add beyond that of existing providers, by offering services across a whole pathway, e.g. for diabetes whereby the GPs and the consultants provide care as part of the overall service offering of the new provider organisation. This allows CCGs to be able to commission pathways of care more effectively, and enables person centred care built around the core general practice offering to become more of a realistic possibility.
3. Provider organisations become ‘accountable care’ providers. The third step is for these new organisations to really exploit the link between the list based care of the core general practice contract alongside the provision of extended services. What this creates is the opportunity to take on responsibility for a budget for a specific population. Innovative service delivery models will enable these organisations to improve the outcomes for a population, and for the organisations as businesses to generate a return on a capitation based budget.
At present general practice is getting lost in the ‘to federate, or not to federate’ question, as a largely defensive manoeuvre. But in many ways this is the wrong question. The right question is what is the vision for how the practice as a business will operate 5 years in the future, and what is required now to make this happen. For CCGs the work is to help practices think these issues through, as an enabler of delivery models that can meet the financial and quality challenges ahead. Practices do not have to change, but CCGs should give all the help they can to those who are up for the challenge.
This article was first published on October 27th, 2013 on www.ccginformation.com
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