STRUCTURE: A GP ‘super-practice’ is seeking to trial new models of care outlined in the NHS Five Year Forward View to ‘break down commissioning barriers’ and ‘innovate at a faster pace’.

Whitstable Medical Practice in Kent, which has over 34,600 registered patients, submitted an application with two other local practices to become one NHS England’s “vanguard” sites. The practices together employ 35 GPs and have a list of over 53,000 patients.

Senior and executive partner John Ribchester told HSJ the practice had “accidently been the forerunner of the forward view” in that it “developed a model of community integrated healthcare with everything but beds”.

Dover white cliffs

Whitstable Medical Practice in Kent has submitted an application to be one of NHS England’s ‘vanguard’ sites

He said moving towards multispecialty community provider model outlined in the document “seemed the natural next step”.

Dr Ribchester said what was “attractive” about vanguard status was that it would allow the practices to “innovate at a faster pace” by “[breaking] down barriers to commissioning differently”.

“If you take on a community capitation budget, then you become a commissioner and provider in one organisation,” he said.

Dr Ribchester added that the “artificial split between commissioner and provider” in the NHS has been a “blocker to rapid progress” in that “both sides of the coin have to agree and are sometimes facing opposite directions”.

The “super-practice” is currently based around a “hub and base” model of five general practice buildings, centred on the Estuary View Medical Centre. About 75 per cent of services provided at the centre are outside general practice. It has a co-located ambulance response base, minor injury clinic, fracture clinic and community pharmacy. It employs 25 consultants, and the local acute trust also rents space for outpatients.

The next step was to “provide bedded care in the community”, he said. Dr Ribchester outlined plans to develop three new buildings around Estuary View: a community hospital, a nursing home and sheltered accommodation. The latter would include a day centre run by Age UK.

“The concept is to provide the whole patient journey, with the exception of things you definitely need a hospital for,” he added.

The contractual arrangements for this would need to be co-designed with NHS England.  

Dr Ribchester suggested GPs were best positioned to lead vanguard models as they are “the most holistic doctors”.

In an exclusive interview with HSJ last week, NHS England chief executive Simon Stevens said the involvement of GPs is the most important and challenging factor facing any area wanting to trial one of the new models of care.