Plans to introduce a range of new care models into the NHS over the next parliament has split the opinion of provider chiefs and clinical commissioning group leaders, an exclusive HSJ poll, in conjunction with advisory firm FTI Consulting, has found.
While CCG leads and GPs favour the “multispeciality community provider” (MCP) model suggested by NHS Five Year Forward View, trust chiefs have thrown their weight behind the “primary and acute care system” idea (PACS).
Both forms were named in the October’s forward view paper as the kinds of care models that could help modernise the NHS and prevent it from falling into the red.
Under the MCP model, GP practices would merge or form partnerships to supply a broader range of services, including running community hospitals.
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While in a PACS, hospital trusts would become “vertically integrated care organisations”, providing a wider range of services from primary to acute care.
The survey of more than 300 CCG leaders, trust chief executives and GPs revealed strong support among all groups for the development of MCPs in their local area, with 96 per cent of CCG bosses expressing enthusiasm for the model.
Support levels for MCPs were also relatively high among trust chief executives with 74 per cent saying that the model was a good idea.
Trust chief executives’ support was however less warm than that of CCG leaders, with only 28 per cent of providers saying they were “very supportive” compared with 69 per cent of CCG leaders.
Some trust chiefs expressed strong scepticism about MCPs in their comments.
One chief executive said: “The concept is good, but to imply that GPs will lead these and be enabled to take on service provision outside their own remit seems risky.
“Why not encourage existing providers of community/social care to embrace primary care and form a new venture?
“As it is stated, the MCP is insulting to the hard work of current providers and assumes GPs can run organisations better, without any evidence.”
Another wrote: “The GP community does not have the skills or capacity to lead the scale of transformation required.”
A third said: “It is not entirely clear how GPs would respond to being a small cog in a bigger operation.”
Enthusiasm among CCG and trust leaders for the MCP model outstripped that of GPs.
While only 42 per cent of GPs thought MCPs would strengthen primary care in their areas, 84 per cent of CCG chiefs believed it would.
The majority of GP respondents feared MCPs would threaten their autonomy, while most trust chief executives said GPs were not best placed to lead integration.
The survey also showed that GPs approved of MCPs but did not favour full practice mergers.
Instead, the largest share of the GP vote (44 per cent) was for practices to federate and share staff and resources, rather than becoming a single body.
Almost a quarter of GPs surveyed said most practices should remain independent.
The PACS model is proving more controversial among healthcare leaders, however the survey indicates it is the preferred model among trust chief executives. Fifty-five per cent of them believed it would improve primary care and just over a quarter of CCG leaders agreed.
While trust chiefs thought the PACS model would speed the integration of services, more than three-quarters of CCG bosses expressed concern that PACS would “increase the dominance of secondary care”.
The survey also uncovered some concerns over the wider five year forward view project in respondents’ comments.
One exhorted national NHS leaders to join up priorities. They said: “NHS England is supporting small providers to join [GP federations] whilst the NHS Trust Development Authority is looking to reduce the number of providers.”
Overall, most respondents said the most likely scenario in five years was that their areas would have a mixed provider economy with both MCPs and PACS providing acute care.
One hospital chief added that there would likely be a mix of MCPs and federated hospitals working across different geographies.
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