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Good news with strings attached: implications of the GP network contract
By Nils Christiansen
There is a tendency when new plans come out of the NHS for people to say they have seen it all before. Would this be a wise response to the long-term plan?
Pleasingly, there is an acknowledgement of the many issues in primary care and a commitment that investment in primary medical and community services will grow faster than the overall NHS budget. Spend should be at least £4.5bn higher in 2024, but the extra money will come with strings attached. If applied consistently, this will mean further change is coming for many GPs in England.
The network contract
A new network contract will route the additional monies and will also incorporate local enhanced services currently commissioned by CCGs. This network contract will be in addition to existing GMS, PMS and APMS contracts. Primary care networks (PCNs) will be responsible for these contracts and will typically cover 30-50,000 patients.
Each network will be responsible for expanded community multidisciplinary teams along the lines of the integrated care vanguards.
The obvious question is, who will actually hold (and deliver) these contracts?
In some parts of the country GP federations are sufficiently developed to do so, and could then subcontract services to member practices or to other service providers as appropriate. In other areas super-partnerships are sufficiently large and geographically contiguous to do so, though they may be concerned about using their unlimited liability partnerships. Elsewhere again, it is possible that existing community health providers may look to lead.
What is clear is that the network contract is supposed to facilitate integrated community-based health care and all new money in primary care will flow that way. We are told that practice participation will be voluntary, but it is hard to see how practices will remain financially viable in the medium term if they do not participate.
Online GP consultations
Digital-first primary care will become a new option for every patient.
Over the next five years every patient in England will have a new right to choose telephone or online consultations instead of face to face consultations.
The plan states this will be “usually with their own practice or, if patients prefer, with one of the new digital GP providers”.
The plan goes on to say that a new framework will be created for digital suppliers to offer their platforms to primary care networks on standard NHS terms. It is therefore unclear whether the digital providers enabling online consultations are supposed to be suppliers of services to networks of GPs, or will be able to hold patient lists themselves.
It has been clear for some time that any increases in funding will go to practices working at scale. Scale working has now been formalised into PCNs. In those areas of the country where there is already an obvious PCN in existence, the immediate focus should be on working out which approach to use for online consultations. Where there is not currently any single obvious PCN, practices would be well advised to reconsider their local joint working arrangements: be that through federations, mergers, primary care homes or the like.
Remember that the new network contract will need to be held by an appropriate business vehicle (there is no indication yet of any restrictions on who could hold them) so you will need to consider who will be the local prime contractor.
Nils Christiansen is managing partner with DR Solicitors, a law firm specialising in primary care.
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