Integrating Primary and Acute Care Systems in Northumbria
Northumbria Healthcare NHS Foundation Trust ("Northumbria") has created a single legal entity, Northumbria Primary Care Limited in response to a request from the local primary care market for support, creating a new model for the delivery of primary care. In March 2015 Northumbria was selected as a Vanguard to integrate primary and acute care systems (PACS) for Northumberland, with the aim of creating closer ties and working relationships with primary care medical services. The success of NPC will help to facilitate the progress of the PACS vanguard project.
The Northumbria Primary Care (NPC) project was built on a foundation of years of successful collaboration between primary and acute care in Northumberland and North Tyneside, with fully engaged local GPs. NPC provides strong clinical leadership and support to help GPs with meeting the everyday challenges facing local practices.
This support allows for bespoke packages to be created, meeting the individual requirements of different GP practices, which includes:
- Management support: providing general practices with back office support, expertise and resources to reduce practice costs and place the practice in a stronger position to win contracts and generate new income streams, allowing the practices to focus on their clinical provision and improved outcomes for patients. This includes quality governance and compliance, payroll management, financial services, human resources and organisational development and estates maintenance; or
- Full support: providing the full clinical service under the practice's primary care commissioning contract by way of a sub-contract between the practice and NPC, with the consent of NHS England.
NPC allows GPs to access substantial corporate expertise from Northumbria as a successful Foundation Trust, but also retain control over the level of service they need in order to run their practice effectively.
As a result of the management support provided by NPC, early results have been very impressive with one member practice recording a 76% improvement in routine access times. Another practice has saved £6,000 in monthly expenditure.
Creating this model has required Northumbria to:
- Set up a wholly owned subsidiary
- Navigate through the highly regulated primary medical care environment
- Designing the governance of Northumbria Primary Care in order that it interfaces with Northumbria's own Foundation Trust governance requirements
Overcoming the challenges
A key challenge within the project was the fact that NPC is not an eligible body to hold a GMS Contract, therefore the design of a contractual structure that complied with the GMS Contracts Regulations was key.
Northumbria and NPC had to work hard on the perception challenge in the region to ensure that GP Practices did not view NPC as a route for secondary care to "take over" primary care. It is very much a partnership and collaborative approach. It was also crucial to ensure NHS England were involved in the journey and were on board with the concept.
It was essential to clearly and concisely set out the "employment deal" for staff once GPs and practice staff transferred to the employment of NPC. GPs in particular required detailed information about the impact on income tax and national insurance contributions, and any impact on pensions.
The governance aspects were significant in terms of arrangements for delegation, reporting, holding to account and decision making between Northumbria as parent and NPC as subsidiary. Escalation of risk management issues and the management of conflicts of interest were also key governance areas to tackle.