Manchester review examines contractual levers for primary care reform

The Healthier Together review has been developing a clinical “case for change” across nine areas in Greater Manchester, including urgent and emergency care, emergency general surgery, primary care and cancer services.

The issue is examined in detail in this week’s HSJ local briefing.

HSJ understands that the model being developed by the review’s primary care team could involve GP practices working in federations to ensure consistent access for patients for 12 hours or more a day, seven days a week.

The model’s champions emphasise it would not mean that individual GPs worked longer hours, but rather that by working in larger teams they could provide services over a longer working day and a longer working week.

A Healthier Together source told HSJ that they hoped to win GP “hearts and minds” to the concept by demonstrating that this could be beneficial for individuals’ work-life balance: a GP working evenings or weekends would have time off in the week, in hours that might better suit their other commitments than existing working patterns.

However, they added that following discussion with CCG leaders the team was recognising there would be “various contractual tools we need to look at to enable some of this vision to happen”. The source suggested that, for example, it might be possible to tie contractual incentives for GPs to performance across an entire locality, rather than just a single practice.

“You might have a group of practices that have [aligned incentives], for instance around A&E activity for minor illness,” they said. “You then start to be able to facilitate those practices to work together to reduce A&E attendances for minor illness. It wouldn’t mean that every practice would have to provide access from 8am-8pm, but it would mean that across the group they work to ensure access from 8am-8pm.”