Executive Summary: Primary care gets super-sized

Primary care’s new mode

HSJ has learned that one of the country’s leading large scale GP providers – which is also a new care model vanguard – is in talks to expand across England.

Modality Partnership, which currently covers a patient population of 70,000 across Birmingham and Sandwell, is in discussions with practices in at least two other parts of the country, it is understood.

This is likely to be encouraging news for NHS England, which expects “a reasonable chunk” of the country to develop large-scale GP providers over the coming years.

Several sources with knowledge of the situation told HSJ that one of the areas where some practices are in talks with Modality is Hammersmith and Fulham, in west London.

Expanding outside its core geographical area would be a significant move for the super partnership. There are other GP providers whose services span large areas – such as The Practice and the Hurley Group – but none of these is designated a national vanguard.

GPs ready for action

The powder is still dry but the BMA’s muskets are nonetheless being prepared for battle.

The union’s GP members have held back from calling for mass contract resignations, instead demanding the union canvass providers’ support in case their demands for “emergency” support are not met.

The representatives from across the UK voted at the weekend for BMA’s GP committee to survey members on their willingness to sign undated letters resigning their contracts.

This “nuclear deterrent” could be deployed and see many practices resign their contracts in six months unless the committee is able to negotiate an “emergency package” of funded help with NHS England.

Delegates at the “emergency” local medical committees’ conference also voted to force the union to find “lawful” ways in which GP practices could refuse to engage with the CQC inspection regime.

GP committee chair Chaand Nagpaul summed up many members’ disparaging view of the inspection regime when he described the CQC as a “bloated behemoth”.

Leaders from the BMA and the Royal College of GPs said that any support package should include fully funded teams to be “parachuted” into failing practices to offer practical assistance.

RCGP chair Maureen Baker added that GPs should follow the example of junior doctors’ leaders in their dispute over pay and conditions. Of which more below…

Strike on

The BMA’s junior doctors committee confirmed on Monday that their final scheduled strike will go ahead on 10 February - but the specifics of the walkout have changed.

Rater than a full withdrawal of labour for 12 hours, which would include emergency care, junior doctors will strike for 24 hours but still provide emergency care (as happened last month).

An HSJ/Ipsos Mori poll before the first strike found that public support for the junior doctors would fall dramatically if they withdrew emergency care.

Johan Malawana, chair of the BMA junior doctors committee, said good progress had been made in talks with Sir David Dalton, but because the government had “shown no movement at all in recognising Saturday as being different from a normal working day” the union was resolved to strike.

He also took a pop at the royal colleges and medical associations which last week urged both sides to reach a negotiated deal, saying: “To those who would urge junior doctors to resolve their concerns in any way rather than industrial action, I ask: ‘What else would you have us do?’”