An alternative future for general practices?
Published 23 October 2015
As the number of general practices facing 'Special Measures' continues to increase, innovative new business models that drive integration, ease the financial burden and address long-term healthcare issues are emerging.
General practice is experiencing a severe crisis. Morale is at an all-time low as GPs struggle with spiralling demand amidst a serious recruitment and retention crisis. So it is unsurprising that some GP practices are banding together in federations providing back office services, and leveraging discounts on locum and medical indemnity costs.
In May 2015, Chesterfield Royal Hospital NHS Foundation Trust became the ‘emergency caretaker’ of the Holywell Medical Group, a GP practice across five sites with 24,000 patients. Royal Primary Care – the name the Trust is operating the GP services under, though it is not a separate entity – has taken over three of the five practice branches temporarily and is considering the possibility of a bid to provide the services long term.
With three primary care facilities under its control, Stuart Ellis, who leads the Transformation team at Chesterfield Royal Hospital NHS Foundation Trust says the new structure can test integrated working around areas such as outpatients, day care or community treatment. “It’s all about removing barriers between hospitals and communities to improve care quality. This integrated arrangement is keeping money within the NHS so it is a win-win situation for patients.”
Ellis says Royal Primary Care is registered with the CQC and has a temporary contract with NHS England and the local CCG to run the surgeries. However, North Derbyshire CCG is reviewing its conflict of interest process as it remains part of the local GP commissioning federation, and without careful arrangements in place could be considered a provider and commissioner of a small proportion of services.
He adds that given the importance of maintaining a service for patients, formal CQC registration processes had to be fast tracked. “If this becomes a growing trend then more work will need to be done over how the CQC registration process works. A change was required to our registration as Chesterfield Royal Hospital but this can take around 10 weeks to make. Yet the existing practice’s registration is terminated overnight – in theory leaving the practice without a CQC registration and therefore meaning it is not able to treat patients. We worked closely with the CQC to keep them informed and to come to a temporary arrangement, but this will need looking at in the future if other practices are to follow.”
Property leasing is another area that requires consideration. The GP Partners had taken out 20-year-plus head leases on their premises, but Ellis highlights that as caretakers the Trust cannot take on these leases on behalf of the former partners given the short-term contract arrangement.
“This poses a risk for NHSPS as it could theoretically have a lease but no service operating from the building at some point in the future – but still be liable for rent. But it can be overcome by a ‘license to assign’ from the landlord to the former partnership – enabling a sub-lease from the partnership to us as the new provider – which would require a new contract with the Trust,” says Ellis.