Simon Stevens, the NHS CEO, has just published his ‘5-year NHS Forward View’. There is explicit reference here that the thrust of development in the NHS must be towards integrated models of care – exactly what GP Care has been seeking to achieve. It won’t be about organisations per se, it will be about patients and how organisations must integrate to serve them better. At the National Association of Primary Care’s (NAPC’s) Best Practice conference last week, it was clear that if primary care is to be ‘delivered at scale’ – the new buzz phrase – then there needs to be support for fledgling community providers who will need to carry the weight of service integration around the patients’ needs.
GP Care is now taking an active role in bringing together provider groupings from all over the country. I’ll be heading up the National Association of Provider Organisations (NAPO) under the umbrella of the NAPC. Many provider organisations / federations have developed without any explicit NHS support, and are just getting by. This is unsustainable if we’re to become strong community providers capable of bearing the weight of integrating care to the patients’ benefit across health and social care. At the conference there was clearly great interest in what we’ve been doing and some very complimentary feedback on what we’ve achieved here at GP Care to date. We’re only scratching the surface of the massive agenda that needs to be delivered and much of my time at the conference was spent networking and seeking to persuade thought leaders and key opinion formers that Clinician-led Provider Organisations (as opposed to Clinician-led CCGs which are commissioning bodies) can be an important component of the delivery of a much more patient-focused model of care.
One big issue is the continuing anxiety about conflicts of interest. Paradoxically, it’s been easier for many federations to establish easier, more trusting relationships with CCGs outside their own patch than with their local commissioners who are effectively paralysed by anxiety about a procurement challenge if they contract for work with their own federation. There is growing realisation that this counter-intuitive quirk is unhelpful and unwarranted. There are plenty of safeguards in the system to manage any conflict of interest and it’s currently stopping the NHS system creating the right changes for the patient. It’s not some ideological concept of whether a provider is ‘public’ or ‘private’ or the ownership structure of that provider that matters; it’s what the quality of the service is to the patient, the integration with other relevant providers and the value to the taxpayer that should dictate our behaviours. I believe federations need to brought into and considered as part of the NHS fold, developed and encouraged to play out their potential to the full; in the interests of system reform, efficiency of care and quality of service to the patient.