• Top GP-led vanguard ”not averse” to becoming employees under “acute trust umbrella”
  • Modality lead says there are no GP-led organisations which can currently be the “lead provider” for a health system
  • Confirms Modality is in “merger talks” with practices across the country

One of the most high profile primary care-led “vanguard” providers is considering whether its GPs should become salaried employees, potentially of an acute trust.

Naresh Rati, executive director of Modality, the Sandwell and West Birmingham-based “super partnership”, said its GPs were “not averse” to “moving under an acute trust umbrella” if it aided service integration.

He also said he did not think many GP-led organisations were currently ready to be the lead provider in new care model arrangements.

Modality, known until last year as Vitality, is one of the most high profile and widely praised of the national “multispecialty community provider” vanguards. The Five Year Forward View said under the MCP model “larger group practices… could in future begin employing consultants or take them on as partners, bringing in senior nurses, consultant physicians, geriatricians, paediatricians and psychiatrists”.

Dr Rati said: “Across Modality we’ve had this conversation about us moving under an acute umbrella and becoming consultant GPs under a salaried model and I don’t think my GPs are necessarily averse to that model, if that’s what it takes to get true integration.

“I’ve drawn up a [draft] salaried consultant GP contract and we’ve shared that amongst our partners to test whether they would be interested and I think they probably are.”

He said they would not necessarily be salaried to an acute trust, but “it could be that the GPs set themselves up as community provider type organisation” which would employ them.

Dr Rati told HSJ there were likely to be benefits to GPs moving to an employment model more similar to the other clinicians they work with.

At the moment the consultants are employed and the GPs [are] self-employed so their incentives look slightly different,” he said. “If equalising that helps their integration I think my partners are there.”

He said the change, if made, would not affect Modality’s day to day operations.

Modality operates across 13 practice sites and is formed of GP partners working together in a “super partnership” structure.

Asked whether a GP-led organisation could take the lead role within an MCP, Dr Rati said: “I don’t see any scenario where a GP organisation, even Modality, will be a lead provider, and then everything else from a system point of view sits underneath it.

“I don’t think as a profession we are of that level of maturity. An acute trust definitely can lead a system but I think it will be a few years away before any GP organisations take a lead role.”

Dr Rati also confirmed it was in talks with several practices outside its area which want to join it. He said: “We are in merger talks with a range of practices up and down the country, of different sizes and different geographies as well. So I think the next 18 months is going to be interesting for Modality.”

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