Trust chief unapologetic about going on the GP acquisition trail

4 July 2018
“Ask for forgiveness rather than permission,” is the advice of an acute trust chief executive who has blazed a trail in acquiring GP practices with a combined list size of some 140,000.
 
David Loughton, chief executive of the Royal Wolverhampton NHS Trust, says the idea of vertical integration in his patch began with the securing of local community health services in 2011 and approaches from small GP practices.
 
“Having the community services contract is very important because that is where a lot of the scope for integration is,” he says.
 
Of becoming a large primary care provider, he says: “GPs approached us and they came to us for a variety of reasons. These were the good practices where the GPs were not making any money because they were employing nurses and pharmacists when their income was going down.
 
“In June 2016 we had a list size of 23,000; now it is 140,000. It generally takes six to eight weeks to bed a practice down and sort out the governance. What we have done is at the wider edge of what the legislation allows: we have a sub-contract of the GMS contract. Primary legislation would be nice but we worked with what we have.”
 
As Loughton points out, the GPs and practice staff enjoyed the recent pay increase awarded to NHS staff covered by Agenda for Change.
 
“GPs are no longer running their own small businesses with things like HR to sort out. The younger GPs in their 30s are not expecting to sign a contract and be in the same place for decades.”
 
Trusting Loughton and his colleagues to provide oversight, the Care Quality Commission sees the trust’s collection of practices as a single entity.
 
The trust runs its own training scheme – currently providing 114 places for junior doctors who can choose between primary care and hospital-based training and education.
 
But what does all this mean for patients? The acute trust call centre now handles all calls to the practices – ensuring it can offer a rapid appointment at a nearby practice if one surgery is fully booked, with beneficial knock-on effects for A&E attendance.
 
GPs can book patients directly into hospital beds – which are turned around in 32 minutes. That speed of turnaround, Loughton says, is faster than north American hospitals manage. The acute trust has turned one of its hospitals into an elective care centre where orthopaedic surgery waiting times are down to two weeks.
 
Social services staff work from the ‘command centre’ and Loughton claims a visitor would be unable to distinguish between NHS and local authority staff. Meanwhile, a public health consultant and registrar employed by the trust work to ensure practices are up to date on issues that can help improve health and reduce demand for services.
 
Given the frequent bad press around the acute sector with claims it sucks up a disproportionate share of health spending, it was important to get patient groups on board.
 
Loughton says: “We’ve invested £2million into primary care for additional services such as physiotherapy, advanced nurse practitioners and social prescribing.”
 
GPs are also provided with a live dataset showing their patients’ contacts with acute, primary and community services.
 
The result, as well as more relaxed GPs, is good for the local health system finances. A&E attendance and emergency admissions covering patients registered with the trust practices have fallen by 14% and 12% respectively.
 
Loughton thinks those figures should earn him a little forgiveness.

Download the July 2018 edition of Commissioning Excellence.

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