GP feds trailblazer urges colleagues to get their heads down and deliver change

8 May 2017

GPs need to stop behaving like meerkats and start thinking about how they and their local partners can deliver primary care at scale and new models of care, according to Mike Smith, a federation trailblazer and board member of the National Association of Primary Care (NAPC).

Smith is a founder member of Haverstock Healthcare, a federation of GPs in Camden, north London that was formed nearly a decade ago.

Addressing a recent PCC event in Leeds, Smith used the example of the federation’s urgent care centre to illustrate what GPs could do together.

Based in a local acute trust’s A&E department and staffed by two GPs, a nurse and an admin person, the centre redirects up to 30% of patients back to the community. They redirect or treat 44% of all the patients arriving at A&E while the centre is open. The centre’s team has also helped 4,000 people to register with a GP practice.

The facility helped the trust’s A&E department move from the bottom five in terms of waiting times in London to the top five within 12 months.

As a leading NAPC evangelist for the primary care home (PCH) model, Smith said: “The 30,000-50,000 population served by the PCH test sites is big enough to get economies of scale and small enough to build trust between practices and to get teams working together. It also often reflects council wards and the nuances of a local area that can make it easier to build philosophical alignment between practices.”

The model is ideal for ensuring GP leadership of primary care at scale, he said.

“When organisations such as acute hospitals or community trusts try PCH-type care they only do it in bits: they don’t have it led by expert, geographically and philosophically aligned GPs and practices.”

GPs, Smith suggested, are too independently-minded to be part of a huge collective.

“Someone said to me that GPs are like Welsh hill farmers: we know our hills and we know our flock.”

He suggested that GPs should be thinking more creatively about their future given the threats to existing PMS and GMS contracts. Too many, he said, are looking to the federation model simply because it is in vogue.

“Is there really a shared vision on why we are doing this? GPs are like meerkats – looking up at what is happening and then running in the same direction.”

Referring to those practices hoping to be involved in multispecialty provider contracts (MCPs), he said: “It’s really important we get realistic about MCP contracts. That looks scarily distant for many GPs.”

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