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Study shows successful hospital management of GP Practices

A report showing how hospital trusts took over the running of primary care services saved some GP practices from closure.

The study by the University of Birmingham and RAND Europe looked at the early impact of “vertical integration”, which happens when healthcare organisations at different stages of the patient journey combine. The study looked at locations in England and Wales, combining a review of existing evidence with personal evidence from GP practice staff and NHS managers.

Why is ‘vertical integration’ an option?

There has been some investigation of this option in the past, which has shown this approach has resulted in better-integrated care for patients, but the evidence from this study showed that the main driver was the sustainability of GP practices that were facing difficulties in recruiting clinicians for primary care.

The study looked at urban and rural practices in England and Wales and found that the most important driver was to keep primary care local to where patients live at a time when GP practices were unable to cope with patient demand or the loss of GPs through retirement or movement from primary care settings.

The benefits were that much of the organisational/business workload was taken on by the trusts, leaving GPs to focus on consultations and delivery, but an unintended consequence of this was that some GPs were leaving sooner than expected – this was largely attributed to knowing that the practice would be sustainable and continue running without financial risk to them, closure or merging with another service.

Royal Wolverhampton Trust experience with Vertical Integration

In previous years, the Royal Wolverhampton NHS Trust had gone down this route, engaging with local GPs in Wolverhampton and Staffordshire who were facing higher patient demands and discussed a vertical integration model which included full integration with the NHS Trust – linking primary, secondary and community care into a single structure.

The arrangement allowed the 9 practices to retain their GP contracts with NHS England, but they would be directly employed by the trust, who cover staffing, contracts, finance, CQC, payroll while allowing GPs to concentrate on patients. The practices would be able to use the Trust’s management information and live patient data to track patients as they moved on their pathway from primary to community and hospital services.

This arrangement meant that over 80,000 new appointments were completed, and were able to offer GPs experience working in hospital as well as general practice, so there was an opportunity to build specialisms and knowledge to adopt key positions across the trust management committees and offer a primary care view that trusts have not experienced before.

Is there a future for integration?

Vertical Integration has developed alongside PCNs, identifying similar issues around workforce, employment and financial risks and the need for community redesign. The study recommended that Vertical Integration was not an option that should be imposed on primary care, but a valuable option to consider for those GP practices that are at risk or under pressure. Patients can benefit from integration, but the study concluded that it must not look like a hospital takeover of local GPs, but an alignment of partners to deliver the best patient services.


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