More flexible GP contract needed to develop integrated teams

The GP contract needs to provide a more ‘flexible approach’ to developing new models of care in order to help the formation of integrated neighbourhood teams (INTs), a report has said.

The report, by the National Association of Primary Care (NAPC), said the contract needs to ‘address some of the serious issues’ in general practice and that ‘a one-size-fits all approach is not appropriate now, if it ever was’.

It looked at how the system could make INTs work, using evidence from the UK and internationally.

The report suggested that in areas where there had been ‘glimpses of success’ with INTs, that there was: ‘A sense of ownership and having built the model yourself rather than it being imposed including having meaningful control over resources including delegated budgets for key areas of activity’.

It added: ‘Some of the big challenges and enablers need national attention: opportunity to relax some contract requirements to allow for greater local flexibility; supporting the evolution of the regulatory system to adapt to a more integrated model; exploration and support for some of the emerging target operating models.’

The report also called on national bodies to review the approach to workforce development in the light of the ARRS scheme and ‘recent controversy’ over the role of PAs.

‘The development of the PCN contract has put a focus on roles but teams need a mix of skills and where possible more people with a wide range of generalist skills,’ it said.

‘Fragmenting care into lots of different tasks increases handovers and the risk of miscommunication and it also means an increased burden and cognitive load for whoever is supervising.

‘The holistic view of the patient may be lost or need to be rebuilt by creating care coordination roles, rather than this being a key part of everyone’s work. All this may also make for less rewarding work. INTs need a new approach.’

The report added that INTs need investment in training, organisational development and ‘space and time to grow’ and ‘protection from the management of policy priorities’.

‘They do not need templates, large amounts of upward reporting and many of the other aspects of programme management,’ it added.

The authors suggested that there was a risk that pilots suggest others should ‘wait to see’ what happens. It warned that often these can be in areas that are already successful.

It said: ‘The risk with pilots, front-runners and other accelerated models is that they can suggest that people should wait to see what is going to happen. It is well understood that the rhetoric that people need to develop meaningful local solutions quickly transforms into instructions to pass a particular set of tests or adopt a nationally set approach.

‘These schemes also often pick areas that are already successful or fail to provide enough time for relationships to develop. They do not seem to be effective at spreading good practice as peer-to-peer learning is not generally done very well.’

It comes as health secretary Wes Streeting has pledged to ‘manage out’ underperforming leaders within the NHS as part of a package of new reforms with a ‘zero tolerance’ approach to failure.