GP premises, networks and new models of care

Dr Brian Balmer, GPC Executive Team, GPC Lead on Practice Finance

GP Premises, Networks and New Models of Care

Dr Brian Balmer

GPC Executive Team

Chief Executive, Essex LMCs

GP Premises

• The players:

– NHS England

– NHS Property Services

– Community Health Partnerships

– Department of Health

– GPC/BMA Law

– Royal Institute of Chartered Surveyors (RICS)

– Lawyers, surveyors, GPs, Trusts, managers, etc

Current issues with GP Premises

• Do not hold your breath!

• Negotiations with NHS Property Services on a template lease

• Negotiations with NHS England on Premises Cost Directions

• Discussions with Community Health Partnerships re fair charges etc

• Primary Care Infrastructure Fund (£1 Billion?)

The Billion Pound note!

• Announced in early 2015, £250 million capital each year for 4 years.

• Wonderful, perhaps not, as we initially dont need capital

• Could this capital be used to create a recurrent income stream. Yes, but no.

• Underspend this year ??

• Use of the fund for other schemes

The good news

• There is an acceptance that we need to reach agreement

• There is investment in skills and people

• CCGs will have premises plans by December

• Practices have been able to plan ahead

• What future there is for GP ownership will depend on the GP workforce

GPs working at scale

• There are 106 GP networks on the BMA Communities database.

• “Network” is a generic term for Practice owned companies, Federations, and “super-partnerships”

• The future for small practices which are not linked to colleagues as providers looks very uncertain

Why form networks?

• Give GPs a stronger provider voice

• Protect income

• Acquire new work

• Mutual support

• Manage practices?

• Control workload?

Challenges

• Competition or collaboration• Service provision within locality and/or outside• Domination by one group over another• Accountable Care Organisations• Merged budgets• Single provider or lead provider with sub-contracts• Time limited contracts• Impact of efficiency savings• Independent advocate or management control

New Models of Care

• Vanguards

• Prime Minister’s Challenge Fund

• Transformation

• Transition

This is the NHS, not a disaster relief Fund.

• ACOs, ICO, etc etc

Merging several failures does not generally produce a success.

New Models (2)

• Designed to improve financial efficiency

• Usually depend on moving services out of hospital

• Some look quite interesting

• These schemes have the ear of ministers etc and so attract a lot of talent

• Combining social and health care is an immense risk

New Models (3)

• MCP or PACS?

New Organisation

GP

GPGP

GPGP

CCG

Full integration

CCG

The future, assuming there is one, will not be dull

Questions are welcome