GPs would be nationalised under plans from the health secretary to make them do more to keep patients out of hospital.
Chris Smyth www.thetimes.co.uk
Sajid Javid is considering radical changes to the 70-year-old structure of the NHS that could see many family doctors directly employed by hospitals instead of running their own surgeries.
He has told Boris Johnson that there are “considerable drawbacks” to the system under which GP surgeries are in effect independent contractors paid per patient by the NHS.
A review of primary care planned by Javid will look at how to better integrate GPs with hospital care as part of attempts to do more to stop people developing serious illness.
Sources insisted there would be no forcible state takeover of GPs, who are likely instead to be given incentives to link up with hospital trusts.
The plans are likely to provoke resistance from doctors who said that the independence of GPs boosts innovation and offers value for taxpayers’ money.
Javid is keen to accelerate the pace of reform in the NHS as he feels pressure to deliver tangible progress in exchange for billions of pounds in extra funding.
He is reviewing hospital management to hold NHS chiefs more closely to account as well as considering “academy style” hospitals with more freedoms, which he hopes will start taking over GPs.
This month he wrote to the prime minister setting out his ideas for NHS reform, telling Johnson that he had “an ambitious agenda that has the potential to be a central plank of your domestic policy legacy”.
He suggested setting up a “new National Vaccination Service” to free surgeries from the need to administer regular Covid boosters, which could keep on some of the non-medical vaccinators employed during the pandemic to administer routine immunisations.
GPs in England were told to prioritise boosters before Christmas, but this week they were told by NHS England to “restore routine services” now that demand for jabs has dropped off.
In the letter, seen by The Times, Javid said: “Whilst there are some strengths to the system of primary care, it’s also clear that the historic separation of general practice from the wider healthcare system as created in 1948 comes with considerable drawbacks including an underinvestment in prevention.” He says he will launch “an independent review of the future of primary care”, to look at “workforce, business models and how GPs work with the other parts of the NHS such as hospitals”.
This month, The Times reported that Javid was considering a new class of “reform trust” in the NHS, modelled on the academy school scheme. The letter said that they would “drive innovation with the freedom to improve outcomes by pioneering approaches including by bringing together primary and secondary care”. The idea has been dubbed the Wolverhampton model after the city’s hospital took over GP practices and cut emergency admissions.
Martin Marshall, the head of the Royal College of GPs, said the current model “delivers exceptional benefits for the NHS”, and that the main problem was a lack of qualified staff. “There has to be a very good reason for changing a model that works well” for all.
Aren’t GPs already run by the NHS?
Although GPs are the front door to the health service, practices have never been owned by the government but are owned and managed by GP partners, whose pay in effect comes out of surgery profits.
How are GPs paid?
Surgeries get a fixed sum per patient, currently £155 a year, with extras for hitting targets on chronic conditions and for offering extra services, with allowances for extra staff such as pharmacists.
Why is the NHS set up like this?
It was a compromise struck as Nye Bevan set up the NHS facing resistance from the British Medical Association and others, who compared the plans to Nazism. To buy off their opposition, he allowed consultants to carry on seeing private patients and GPs to remain independent small businesses.
What is the case for reform?
Joining up care and preventing chronic illness is a key goal of health systems globally. Some argue that the divide between GPs and hospitals hampers this integration. Hospitals lack the opportunity to prevent disease while GPs lack the resources and financial incentives to prevent disease they do not pay to treat.
What is the case against?
GPs are established, developing long-term local links and are responsive to patients, not looking to the NHS hierarchy and an unresponsive bureaucracy.
Are any GPs paid a salary?
Yes, and the number is growing as fewer younger doctors want the responsibility of in effect running a small business. The number of salaried GPs in England has gone from 6,650 in 2009-19 to 11,000 in 2019-20, a rise of 65 per cent. GP contractors have fallen 27 per cent from 26,400 to 19,250.
What does nationalisation mean in practice?
Javid’s allies insist family doctors will not be forced to hand over their surgeries. They are more likely to be offered incentives to become part of larger NHS organisations, often hospitals.
What will this mean for patients?
The goal is a more seamless link between doctors and specialists, meaning problems picked up quicker and patients given help staying well. Critics say the changes will not address the fundamental problem of falling GP numbers.