By The King’s Fund (2014)
The pressure of a growing and ageing population (many of whom have long-term conditions, compounded by risk factors like obesity, smoking and alcohol misuse), is made all the more pressing by the well-documented financial challenges that the entire health system faces – but are keenly felt within general practice. For a number of years, we have been making the case for the central role that general practice should play in delivering integrated care, alongside colleagues in the community, social and acute care. We have recently worked with four groups of general practices across England that are already working in this way, adapting local contracting and funding streams to influence the way they work together with local providers to deliver services to better meet the specific needs of their population. However, the technicalities of these contracting and funding streams are complex and not well understood by many general practices across the country. This prevents many from innovating in a similar way.
In Commissioning and funding for general practice, we argue for a new approach to funding general practice, where GPs take control of a population-based capitated contract that enables them to either provide or ‘buy’ services for the patients on their registered list. Commissioners would build certain outcomes into this contract, but would not specify how they are to be delivered – practices would be responsible for finding ways to work together and in partnership with other providers to deliver care that achieves these outcomes. Over time, we see ‘family care networks’ emerging that provide forms of care well beyond what is currently available in general practices.