Last week the King’s Fund stirred things up somewhat when it published a no-holds-barred report stating that the recent NHS reorganisation had been a disaster and a waste of three years. The report – first published by the BBC – led to all sorts of politics and Labour calling for David Cameron to make a personal apology, whilst themselves being accused of “crying wolf” over privatisation.
This week, another King’s Fund report – this time on the topic of the NHS Five Year Forward View – promises to cause further ripples through the healthcare world. The report calls for fundamental changes in how health services are commissioned, paid for and regulated to deliver the vision set out in the five-year plan published last October.
Multispecialty community providers
At the heart of the five-year vision is the multispecialty community provider (MCP) model of care. This involves the development of federations, networks and super partnerships to enable general practices to operate on the scale required to deliver a wider range of services. These services would include those provided by some specialists, alongside other professionals such as nurses, therapists, pharmacists, social workers and psychologists. The report recommends that “NHS commissioners should work with interested and capable general practices operating at sufficient scale to establish MCPs”.
So far at least, it seems that this model is proving popular. NHS England has received 170 applications from GP-led ventures wishing to become MCPs. The successful applicants will share £200m set aside by the Government to pilot the new models of care, which will certainly help these ‘super-practices’. However, according to the King’s Fund, getting forward finance correct is crucial to the success of the ventures, which is why it has recommended a different funding model.
The report recommends that MCPs should hold their own ‘capitated budgets’ for providing out-of-hospital care.
The think tank has previously argued for the use of a population-based capitated contract linked to the delivery of agreed outcomes as the best way of commissioning MCPs. They suggest that budgets should be determined by a combination of population size, need and the range of responsibilities included in it, including funding for general practice. The scope of budgets could be expanded as emerging MCPs demonstrate their ability to work in this way.
Crucially here, the report says: “MCPs would use their budgets to take ‘make or buy’ decisions. This would mean delivering services directly where possible or commissioning services from other providers. There would be a blurring of the distinction between commissioners and providers to enable GPs, in partnership with other clinicians, to deliver more integrated services in the community.”
Along with a greater responsibility for commissioning and providing care comes a need for additional skills – including contract negotiation and management, financial management, utilisation management, and the management of clinical quality in order to oversee contracts and deliver the expected outcomes.
This raises the question of the need for training, where the time for it will be found and who will fund it. And, if resources are to be brought in, how do you recruit the right people?
Conflicts of interest
Another issue with this approach is the need to manage potential conflicts of interest, such as practices involved in bidding to provide services under the terms of the new contract being excluded from the process of commissioning these services. It would also be important to develop transparent governance and accountability to avoid any suggestion that GPs are gaining inappropriately through their involvement in MCPs.
The chapter on MCPs in The King’s Fund report, which can be found here, is well worth reading and certainly raises a number of good questions. Perhaps the best point from the report therefore is that this can’t be a quick fix.
What do you think of the think tank’s suggestions? What do you think of the MCP model? Have you already applied? Let us know by commenting below or let us know in the Practice Index forum.