'Huge appetite' for primary care at scale, says NHS England chief

In an interview with HSJ, the NHS England chief executive said primary care home “goes with the grain”, GPs were “up for change”, and “thousands” of practices would adopt the model in the coming years.

Primary care home is being developed by the National Association of Primary Care. Fifteen pilot sites have been supported and funded by the new care models team.

The model proposes practices collaborating across populations of 30,000-50,000, establishing “hubs” to provide an extended range of services via multidisciplinary clinical teams.

It operates on a smaller scale than the MCP model described in the Five Year Forward View, and does not encompass the full range of community services. Primary care home does not require new organisational forms, unlike a fully integrated MCP model, and does not give a provider responsibility for population health via a new type of contract.

GP hubs working with populations of 30,000-50,000 are considered to be the building block of both MCPs and the larger primary and acute care system model. The hub model is widely cited in sustainability and transformation plans.

Mr Stevens said: “There’s a huge latent appetite for something like [primary care home] – not necessarily full blown integration between practices and super-partnerships, but something that is in the middle ground between individual practice sovereignty and complete pooling of assets and employment and the contract.”

He revealed NHS England would work with GPs and the Royal College of GPs to “support and incentivise that move”, for instance via the additional money ringfenced to support the GP Forward View.

Future waves of investment in primary care estates would be targeted at “supporting schemes that are helping people operate on this broader scale”.

Extra staff in primary care, such as more mental health therapists and clinical pharmacists, would be “supporting groups of practices, rather than just individual practices”.

Changes to out of hours, 111 and indemnity support would also help form a “combined set of things that will be responsive to what GPs are asking us”, which would also bring about more shared working.

While a number of areas would move to a fully integrated MCP, “we’re not envisaging that’s going to be the majority of the country any time soon”, Mr Stevens said.

Instead: “The action is really going to be… thousands of practices are going to be involved in team working with other practices in a structured way. I don’t think thousands of practices will necessarily be in a full blown MCP contract over the next 36 months.”

Mr Stevens said national leaders were deciding how much transformation funding would be allocated to new care model vanguards, and that the overall amount available would be £100m, as it was for the last two years.