‘We will engage’ with GPs on future of partnership model ‘in decline’, says Streeting

The GP partnership model is ‘in decline’ but the health secretary ‘genuinely’ wants to ‘engage’ and ‘consult’ with the profession regarding its future, he said today.

Responding to a question from Pulse at an event by Institute for Public Policy Research (IPPR) today, Wes Streeting said he does not think moving to ‘neighbourhood’ healthcare has to mean ‘moving away from’ GP partnerships.

However, he said he has ‘observed a GP partnership model in decline where very soon we’re going to have more salaried GPs than partner GPs’ and where partners have ‘anxieties’ themselves about the situation.

Mr Streeting stressed though that the independent contractor model is not his ‘first consideration’, and instead he wants to focus on one of his key ‘shifts’ – to move care from hospitals into communities.

‘My first consideration is how do we make sure that general practice is attractive to those thinking about careers in medicine, and how do we do more in primary care and the community and get some of those services shifted out of hospitals closer to where people live,’ he said in response to Pulse’s question.

Last year, as Labour’s shadow health secretary, Mr Streeting came under fire from GPs when he said he wanted to ‘tear up’ the ‘murky and opaque’ GP contract.

But today, the health secretary claimed that he ‘started deliberately a debate’ on this issue, and that he has been ‘genuinely interested’ and ‘wanted to work with the profession to rebuild general practice’.

He told attendees at the event: ‘I did mean to open a debate about the future of the partnership model. What I observed is a GP partnership model in decline where very soon we’re going to have more salaried GPs than partner GPs, and where GP partners themselves are describing anxieties about the future of their profession generally, about the future of the model specifically.’

The health secretary stressed he does recognise the ‘strengths’ of the partnership model, such as ‘the efficiency, the innovation, the continuity of care’.

This was was also identified by Lord Ara Darzi in his review last week, which said that GP partners have ‘the best financial discipline’ in the NHS, and also recommended increased funding for general practice as part of a ‘left shift’ of rebalancing care towards the community.

On consulting with GPs, the health secretary today said: ‘I think this [debate about the partnership model] is a good example of how when we say we’re going to consult, we’re going to engage, and we’re going to listen – we genuinely mean it.

‘I know that when most people hear politicians say they’re going to consult, they think we mean impose our view with a veneer of engagement. That’s not how we’ll proceed. Where we’re clear about what we want to do, we’ll say so. Where we’re engaging and consulting, we’re genuinely interested in finding answers to our questions.’

He also repeated his criticisms from last week of the BMA’s GP Committee, claiming that their approach runs counter to the feeling among GPs who are ‘really up for reform’.

‘[GPs] want to see the left shift and they want to see this Government really deliver on our ambitions for general practice and primary care. That is why the confrontational approach of the BMA’s GP Committee is unfathomable,’ Mr Streeting told attendees.

The IPPR event today launched the final report of the think tank’s ‘health and prosperity commission’, which was co-chaired by Lord Darzi.

One of the key recommendations is to move to a ‘neighbourhood’ health service whereby GP practices operate under a ‘hub and spoke’ model rather than as independent contractors.

The IPPR argued that while the partnership model has ‘its advantages’, its ‘limitations are also increasingly visible’, and that ‘any success in bringing more care’ into the community ‘will need a new approach’.

A ‘hub and spoke’ model would mean that the ‘hub’ operates like a PCN and ‘focusses on delivering scale’ while individual GP practices ‘focus on delivering continuity’.

The report said: ‘At a minimum, we suggest new primary care hubs – one for each neighbourhood, possibly piloted in the first instance within HAPI Zones – which join up primary care, community care, mental healthcare, diagnostics, social care access and some public health services (eg services provided through the ringfenced public health grant).

‘These would come within a single site, where patients can access ‘teams without walls’ under one roof.’

The think tank urged the Government to take forward this proposal, which it estimates would cost £1.25bn per year for 10 years.

While Mr Streeting did not commit to implementing this model and other IPPR recommendations, he noted today that their work has ‘been really helpful’ in ‘framing’ his department’s priorities and policy.