NHS England chief executive Simon Stevens has proposed that some hospitals should be allowed to open their own GP surgeries.
Speaking at the Royal College of GPs’ annual conference in Liverpool, he described the “need to tear up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists”.
Mr Stevens suggested also that GPs could form expanded group practices with other health professionals, including hospital consultants. Such groups could control delegated budgets for a whole population.
He said that in some locations – such as deprived, urban communities where practices are struggling to recruit GPs – hospitals might be allowed to open their own GP surgeries with registered lists.
Such a model would allow primary care practices in these areas to benefit from investment from their local foundation trusts.
Mr Stevens also proposed that GPs could form expanded group practices that directly employ hospital consultants or take them on as practice partners. They could also take on a delegated annual budget to look after the whole healthcare needs of their group of patients.
Such groups could include a broad spectrum of health professionals, such as GPs, consultant physicians, geriatricians, psychiatrists, community nurses, therapists, pharmacists, and potentially some social workers, he suggested.
They could take on ownership of their local community hospital, to which they could add more local services, such as hi-tech scans, outpatient chemotherapy and dialysis.
Mr Stevens’ proposal is similar to the “accountable care organisation” model, a term created in the US which refers to groups of providers contracted to jointly provide all care for a given population for a defined period. Their funding is based to some extent on quality and efficiency performance.
“The national debate on the NHS is now picking up steam, and GP services are rightly at the centre of it,” Mr Stevens said.
“But, alongside more doctors and more funding, we also need new and better ways of caring for patients, especially older people at home.
“GPs themselves say that in many parts of the country the corner shop model of primary care is past its use by date.
“So we need to tear up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists, and where patients with chronic health conditions are increasingly passed from pillar to post between different bits of the health and social services.”
He said 30% of emergency patients admitted to hospital were there for less than a day, which suggests their admission could have been prevented by better primary and social care.
NHS England is due to publish a “NHS five year forward view” this month, which will include details on new provider models for out of hospital services.