• Author of government’s GP Partnership Review says community health teams have not integrated with primary care
  • Review, commissioned by DHSC and NHS England, is published
  • Supports primary care networks, which should have “clinical and service direction” of community health teams
  • PCNs should be allowed to overhaul GP extended access services

Community health teams have not integrated with GP services and should in future be “based in” and “under the clinical and service direction” of primary care networks, the author of a government review of general practice has said.

The review of the GP partnership model, led by Hampshire GP Nigel Watson, was published today.

Its recommendations included that “multi-professional community health teams should be based in and work under the clinical and service direction of the PCN”. They “could remain employed by their existing employer” – which are trusts or social enterprises – but be “embedded in practices day to day”, it said.

The NHS long-term plan, published this month, proposed “expanded” community health teams based with PCNs, which are “based on neighbouring GP practices” covering populations of 30-50,000. It said: “In many parts of the country, functions such as district nursing are already configured on network footprints and this will now become the required norm.”

Dr Watson was more sceptical about progress so far, telling HSJ: “There are many of us who have tried working in an integrated way with community nursing and it does not happen. There are very few places in the country that have got their community nurses working really productively with general practice.”

Dr Watson was a leader of a prominent new care model integration project in Hampshire and is a member of the British Medical Association GP committee and chief executive of Wessex Local Medical Committees. The review was commissioned early last year by former health secretary Jeremy Hunt and NHS England chief executive Simon Stevens.

He said PCN leadership would include community health staff, adding: “You will have a leadership team – we wouldn’t call it a board because they’re not statutory bodies – which community nurses would be part of.

“The key bit is you work within that geographical footprint and it might attract more resources to deliver more services as described in the NHS plan.”

Dr Watson said the requirement in the long-term plan for PCNs to take on substantial budgets, staff and other responsibilities would lead some practices to decide to merge to create a larger practice which could host these functions. Others may form joint companies; ask community health providers to do it; or use existing federations – though these rarely match PCN footprints.

“I can see practices joining together to form companies, I can see mergers happening, I can see them partnering with trusts – I can see all sorts of different models emerging,” he told HSJ.

Dr Watson added that PCNs should be given the budget for current GP extended access services, and be allowed to scrap or overhaul them. So far, they have been nationally funded and mandated. 

He said a typical PCN may be spending £300,000 on extended access, and added: “You could do a lot with that. I’m not saying you shouldn’t provide a [GP] service until 8pm at night [but] you can look at balancing that [with other priorities].”

He said it should become the “norm” that this budget goes to PCNs instead of external contractors, which many areas have bought in.

Responding to the review, Matthew Winn, chair of the community network, part of the NHS Confederation and NHS Providers, and chief executive of Cambridgeshire Community Health Trust, said: ”The NHS long term plan has set out the ambition and resources for this closer working to be delivered through primary care networks. It is important that local areas determine how best to configure these networks and deliver community-based services in a partnership approach. It would be unwise to specify a single structural approach to local integration.

”Evidence and experience from around the UK shows that mature and trusting relationships are the cornerstone of teams that are joining up services. Clinical leadership and accountability need to be clearly set… It is unwise to start an integrated partnership with a focus on structure and who has the right to determine what other professionals do on a day to day basis.”

Updated on 16 January to add Matthew Winn’s comment