Today, the Herald allows this claim, unchallenged:

Even by their standards, the brass-necked cheek of that claim stated as if it was a fact, with no source, not even the a GP union shoddy survey.

What research is there, either way?

From the Health Foundation in February 2023 and oh so easy to access by even a Herald journalist:

Some acute NHS trusts are now acquiring general practices and employing GPs – for example, to staff urgent treatment centres. What is proving more controversial is hospitals employing GPs to deliver a fuller range of GP services, such as the Royal Wolverhampton NHS Trust, Northumbria Healthcare NHS Foundation Trust and others.¹⁰ Some have suggested this might be an organisational and employment model for the future¹¹ and the idea appears to have some political support from senior Conservative MPs.¹² The Labour party has also proposed scrapping the independent contractor model, with GPs becoming salaried NHS staff¹³ – and one option for doing this could involve NHS trusts employing GPs.

This is not a purely UK phenomenon. Similar merging of some general practice and community services with hospital care has happened in Spain, the US, New Zealand and Denmark.^14,15,16,17 The stated rationale includes improving collaboration between services, better management of the population’s health needs, sharing back-office support such as premises and IT, making general practices more sustainable and accommodating changing career paths and GP training preferences.

The Royal Wolverhampton NHS Trust, a large acute and community health services provider, currently has eight directly integrated general practices, governed by a designated division in the trust comprised of primary care clinicians and secondary care managers. The trust has established links between its community health services and GP practices, creating a rapid intervention team intended to improve health in the area and reduce unnecessary demand for emergency care services. Work is under way to establish a ‘command centre’ that handles calls to all practices. GP practices owned by the trust also have access to a live dataset showing their patients’ contacts with acute, primary and community services.¹⁸

In their conclusions:

UK studies of vertical integration of acute trusts and general practice are limited, but research is starting to emerge.^20,21 Early evidence on the professional and management effects of these new models²¹ points to a mix of potential challenges, such as:

• fear of loss of GP and practice autonomy
• increased bureaucracy associated with larger NHS bodies
• a reduction in local patient and community attachment to their practice
• potential damage to relationships with other local GP practices
• threats to existing multidisciplinary team working
• staff leaving if they feel ‘taken over’.

But the research also identified potential advantages of these new ways of working, including:

• better links between GPs and secondary care services and colleagues
• less management and regulatory pressure for GPs
• more training and development opportunities and resources for all in the primary care team
• new career pathways for practice managers
• greater potential for service innovation.

There is some early evidence of impact on quality and service use associated with the integration of general practice with hospital trusts in the UK. A quantitative study found a modest reduction in emergency hospital admissions or readmissions for patients of vertically integrated practices compared with a ‘synthetic control’ group of non-integrated practices, perhaps due to the removal of some barriers to more effective coordination.²⁰ The authors note the similarity of their findings with those of a study of vertical integration in Portugal.²²

More opportunities than disasters ahead?