Tony Blair’s think tank has put forward a new vision of primary care with ‘far fewer groups of GP practices’ and 250,000-patient lists.
In a report published yesterday, the Tony Blair Institute (TBI) also urged the Government to implement a ‘digital health record’ for every citizen, which would replace the GP record, by 2029.
The think tank has put forward its suggestion to Lord Darzi’s review into the NHS, which is currently gathering evidence, in order to report next month, and will inform a new 10-year strategy.
On the state of primary care, the TBI report said that the ‘traditional model of ten minutes with a doctor to discuss one problem by the time you’re already sick’ is still the norm in some places, but practices are ‘increasingly’ adopting a population health management approach.
It argued that ‘commissioning primary care at greater scale would propel this trend’, noting that some federations already look after ‘far greater numbers’ than the standard PCN size, which is between 30,000 and 50,000 patients.
The report continued: ‘We recommend that NHS England considers a new contracting mechanism for primary care that is outcomes-based, commissions for scale (populations of 250,000 patients) and has a gain-share component.
‘This would see groups of practices benefiting financially from better outcomes and lower rates of hospital admissions; it would also facilitate the movement of funds from secondary to primary care over time.’
Tony Blair’s researchers highlighted that this ‘would not be mandatory’ and would ‘run in parallel’ with the GMS contract – but practices should be ‘incentivised’ to join larger groups, by offering perks ‘on condition of meeting outcomes-based targets’.
‘In time the primary-care landscape would change to one with far fewer groups of primary-care practices – and meaningful choice for patients over which group they register with,’ the report added.
On the digital health record, the TBI said it would be the ‘single source of truth’ for all health and care data, which ‘currently sit in silos across hospitals, GP practices, pharmacies and phones’.
In order to facilitate its creation, the think tank recommended that legislation is changed to make the health secretary ‘joint data controller with GPs’, which it had hinted at before.
This new record would bring together patient data from all NHS organisations as well as private providers, and would support the ‘development, adoption and spread of AI technologies in the NHS’.
The TBI researchers said the digital health record would have the ‘most impact in primary care’, by becoming an ‘AI doctor’ for patients, while helping to advance the Fuller stocktake.
They recommended that the Government introduce legislation to ‘compel’ all suppliers of electronic health records to be interoperable.
This digital record would ‘help the NHS prepare for the AI era’ since AI is ‘trained and deployed’ on health data.
Other recommendations
- The NHS should invest in development of a national AI-powered health analytics platform to ‘drive clinical decision-making’ for doctors;
- This would be trained using anonymised data from the digital health record (DHR);
- Over time, the platform would become a ‘personal digital health assistant’ or ‘AI doctor’ which could help with managing long-term conditions or triage when patients are unwell.
- It could be incorporated into GP management systems
- The DHR would allow GPs to monitor risk of patients with long-term conditions and only see them when clinically necessary.
- It would also allow patients to choose services – even the private sector – while preserving continuity with GPs.
- The DHR would ‘allow patients to propel themselves through the referral, investigation and consultation process without constant back and forth with their GP.’
- It would help with managing same-day care needs as patients ‘could be more effectively navigated to the right service first time’.
Source: TBI
The Tony Blair Institute also said NHS England needs to ‘gain greater control’ over GP IT management systems, which are currently commissioned independently by each practice. According to the report, GPs ‘lack the contractual levers to demand change’ of the two dominant suppliers – EMIS and SystmOne.
When building the digital health recird the think tank urged the Government to either ‘procure an entirely new practice-management system for general practice or work with an existing one to build out the tech stack’.
Beyond general practice, the report also argued that the digital health record can help boost prevention, highlighting the ‘potential of GLP-1 agonist-type drugs’, such as semaglutide.
It said it is ‘simply not feasible’ to roll out this drug routinely for weight management in general practice, arguing that the NHS needs to make ‘greater use’ of community pharmacy.
Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said he thinks the report is ‘very poor’ as it ‘ignores workable solutions’ in favour of ‘untested and potentially expensive interventions’.
He told Pulse: ‘Suggestions such as increasing the use of GLP-1 agonists overlook the high cost of these drugs and their side effects. And the new screening tests that are mentioned in the report need evaluation in clinical studies before their wider rollout.’
Doctors’ Association UK GP spokesperson Dr Steve Taylor told Pulse that in his opinion the report ‘fails to address the real needs of people to connect their care and have the support of health professionals, particularly GPs’.
He said: ‘There is so much evidence that supports that continuity is key to good health outcomes.
‘In my experience of patients accessing results via the current NHS apps there are a lot of questions about results, explanations of letters, wording and support needed.’
Dr Taylor said that the ‘focus on data points rather than relational care is a problem’ and that not putting ‘patient wellbeing at the centre of the policy is a failure’ too.
He added: ‘There is a huge underestimate of the role of health professionals and in particular GPs in supporting the healthcare journey. Focus on this is vital in any policy decisions. Leaving this to the healthy and wealthy results in poor policy decisions and must include patients and healthcare workers on the front line.’
The report comes after Wes Streeting has welcomed back some key Blair-era figures to advise on NHS policy. In addition to Lord Darzi, this includes Paul Corrigan, who will help with the new 10-year strategy, and former health secretary Alan Milburn, who spearheaded increased private involvement in the NHS.
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BS Bingo.
Perfect and peachy for privatisation. Another dodgy dossier from Tony. I generally find if you know nothing about a subject it is best to be quiet. Make assumptions based on ignorance can end up invading Iraq, just saying.
So on one hand they are advising continuity -should be ‘Thick Tank’
Good old Tony. Nothing if not consistent. Obsessed with the data. Doesn’t shut up about digital ID either.
‘Population health’ was a term coined by US private healthcare companies who figured that they may save money by preventative medicine through their healthcare systems.
Their public health systems are state controlled while health is private so the private healthcare systems cannot target preventative medicine through public health measures as there is no link between healthcare and public health.
IN the UK both public health and healthcare are state managed, so with decent government, preventative health can be optimised through correct public health measures; that is the discipline that is devoted to public health and best placed to manage it. (Think fast food and sugar taxes instead of costly obesity injections and diabetes medications-you know the bits that prevent the problem rather than tinkering around the edges of treating it. The bits that benefit people rather than pharmaceutical companies).
So leave ‘population health’ to the US private healthcare systems it was created for. And our government can try implementing the public health measures we have already been told we need. Predominantly the measures on obesity from the Dimbleby National Food Strategy. As diet and obesity are the main driver of poor health now in the UK (and globally).
Oh yeah. Forgot. Because private healthcare in the US has the data divided up and owned between different healthcare companies they can’t drive the ‘population health’ approach. Will need the NHS full population data set.
What to do then Tony?
Chase down the NHS data I guess.
Bugger, my entire region is only 170,000. That’s us finished. I suppose living outside of London or any major city means you’re an irrelevant annoyance anyway
Has Starmer and the Labour party still not got it through its thick head that anything tainted with the TB brand is interpreted by most people as BS and lies? The rich ex-PM TB (his wealthy family, and his predictable institute) is all about securing more wealth and rent-seeking for himself and his 1% elite friends, and nothing to do with the interests of our NHS or the country. Drop the TBI.
For the future of primary care, will the BMA now ballot all GPs (including ex-partners like me, and locums etc), take the conversation to the country, and call a real strike?
I thought patients liked continuity?
They might also like to attend a local Practice, rather than one 80 times bigger, and, presumably, 80 times further away????
No longer will there be any GPs on the Scillies, Orkeys, Shetlands, or most of Mid-Wales or North Wales !
Good news.
The worse the NHS gets for patients, the more demand for Private Practice, and the more opportunities to escape the ghastly NHS.
The worse the NHS gets for patients, the more likely it will finally be replaced with something that works.
The only scaling up GP PCN CDs (not all) will be interested in, is the scaling up of their admin role oversized PCN CD payments, bank accounts and limited companies – the rest of the chat will simply be PCN window dressing to obscure the devastation they have caused to core General Practice, patients and the careers of their colleagues. If I were not a partner I would also have been crushed by this unsavoury PCN CD (not all) caboodle but continue to recognise the misfortune of others.
If 250k is good does that make 2.5 million better? Or perhaps 2 x c30 million patients in 2 practices ‘North’ and ‘South’?
On second thoughts perhaps being too big to fail means Primary Care will get access to those peachy bail outs secondary care gets periodically. As things stand
currently a GP practice overspend leads to a house repossession.
Blair’s messianic ignorance epitomises the struggle we face to recoup and regroup a decent Health system. Blair is beholden to the commercial entities which are riven with opportunists in government and its US client Accountable Care Organisations. The NHS ‘third-way’ was a demonstrable failure writ large. Population Health Management will not be better or cheaper, eg the perfect nonsense re GLP1 agonists being “prevention” and available through pharmacies. The only winners are the pharma industry and HMO corporations. Blair is either too stupid, bigoted or bent to realise this. Blair ‘advising’ Darzi is a bad and conflicted joke which the nation would be better without. Comments below and from Prof Majeed and Dr Taylor are key and correct – Tony McKinsey Blair should be dethroned at pace and scale.
This is the sh1t that is current destroying primary care. It originated from these people. This is the model that will kill British general practice. It’s centralised, Stalinistic, administrative, hospital biased, and ignorant. You can almost smell the words “MBA” reading through it. It’s yesterday failure rehashed for yesterday’s surgeon fixated on the destruction of your local GP practice. This is it. Everything I’ve come to detest in NHS policy. The reason I can no longer work as a GP. Moronic
Good news.
The worse the NHS gets, the more people realise it needs replacing with something that works.
Good news.
The worse the NHS gets, the more demand for Private Practice, and the more doctors can escape the ghastly NHS m
The amount of effort we make to filter stuff on systmone from other organisations because their templates fill up the new journal with 3 pages for a wound dressing makes me think these people have never talked to anybody within 200miles and 20 years of seeing a patient in primary care. Their biggest influence is likely money men who want to find things they can sell to the Govt and get paid for.