Creating an integrated primary and secondary care system – Is your trust ready?09/11/17
The Five Year Forward View makes it clear that the integration of primary and secondary care systems is fundamental to the future of the NHS. As a result, NHS Trusts and Foundation Trusts are having to develop strategies to integrate with primary care providers, in order to meet CCGs’ commissioning strategies, and to successfully secure contracts in a wider market place. Where they are no longer just competing against one another, but also against large GP federations and other private healthcare providers.
Hurdles for Trusts
Many Trusts are starting to realise that there are hurdles to overcome to successfully integrate with, and provide, primary medical services. For example:
- Regulatory requirements – The legislative framework governing primary medical services is complex and highly prescriptive. There are differing restrictions on who can hold various types of primary medical contracts. For example, Trusts are not eligible to hold GMS contracts, the most common type of GP contract.
- Premises issues – Primary medical service contractors are usually entitled to receive reimbursement from NHS England or CCGs, for certain premises costs, such as rent and rates. However, the position will vary depending on the type of contract, and the Premises Cost Directions (governing the reimbursement of premises costs for majority of GP contractors) are complex. It is, therefore, essential that certain criteria are complied with in order to secure such reimbursement.
- Employment considerations – Where Trusts are taking over provision of primary medical services, careful consideration needs to be given to staffing arrangements, in particular the provisions of TUPE and NHS Pension arrangements.
How Capsticks can help
We originally acted for a mental health trust, which was one of the first Vanguards to implement a new multi-specialty community provider model with local GP practices. Despite the restrictions on eligibility on most primary care contracting options, and the complexities around the integration of primary and secondary care contracting. We developed a bespoke model which provides a joint working solution protecting both Trusts and GPs, in relation to the operation by Trusts of primary medical service contracts.
The model not only gives Trusts the required level of control, but it also provides assurance for GP partners in relation to: (a) on-going premises obligations whilst maintaining the availability of premises reimbursement and (b) NHS pension availability to the former partners and staff.
The model has now been successfully implemented by a number of our other Trust clients and could easily be utilised by other Trusts and GP providers who are looking to integrate.