The key to unlocking new models of integrated care

Many column inches, in HSJ and elsewhere, have outlined the growing, and now urgent, need to reform general practice.

‘The key to unlocking the process towards a new model of care is getting general practice on board’

Conversations with those in the NHS who have been thinking about how to progress towards new models of integrated care have two common themes.

First, there is an artificial split in the thinking between the models of multispecialty community providers and the integration of primary and acute care services.

Second, in the rush to define which model is “right”, pejorative language is emerging: “It is all about a takeover of general practice” and “[GPs] won’t be able to do that without [hospital] support” are two phrases we have heard.

In the end, both models are about the same thing: providing a more coordinated service to a given population, delivering better outcomes and doing it at less cost. It all depends whether the local acute hospital is included at the start.

Either way, the key to unlocking the process towards a new model of care is getting general practice on board. It is not the only element and it is not necessarily the most important element, but it is the necessary prerequisite.

At least three areas need to be addressed to get GPs on board:

1. Hearts and minds

Practice by practice, emerging leaders of these new organisations will have to persuade GPs to come on board with their proposed model by answering a range of issues. Why is this going to be better for my patients? Does it address the day to day frustrations they and I face in getting the right care? How will this make a difference to my incredibly difficult and busy day?

2. Technical

Once on board intellectually and emotionally, GPs will start to think about the technical issues: “What about my premises?” “We earn half as much as the practice down the road – how does that work?” “What is happening with my pension?”

3. Contractual

Taking on general practice is not straightforward contractually and depends on how far GPs are willing to change. Indeed, the many practices on a general medical services contract have a lifetime right to continue that contract.

Within those contracts, who does the contracting and how the provider is structured have VAT implications, in addition to legal considerations.

Then there is the further question of how European Union competition and procurement rules come into play.

None of these areas are insurmountable, but they are challenging. And once unlocked, the momentum will build behind providing better services for the population of England.

Mike Farrar is a member of PwC’s Health Industries oversight board and Tim Wilson is PwC’s Health Industries consulting lead partner