Disastrous reporting: NHS take over of GP surgeries can be a very good thing

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?


3 thoughts on “Disastrous reporting: NHS take over of GP surgeries can be a very good thing

  1. I thought that Scotland doesn’t have NHS trusts, but as usual what they mean by ‘Uk’ equates to England.
    It’s same old story from the pretendy ‘heraldScotland’, SNP bad, Scotland is a mess, even if you are receiving excellent health care in Scotland, it’s really really bad. Just have to hope most folks see the pretendy ‘Scottish’ rags and televised pretendy ‘Scottish’ stories under English Broadcasting control, for what it is, propaganda.

    Liked by 4 people

  2. One of the oddities of growing up is leaving comics behind, but I honestly don’t actually any “McArdle’s Gargle” as a must read when I was a kid…

    Presumably Helen was struggling to meet her monthly target of 20 bogus ‘healthcare’ stories, and began dredging for inspiration, ending up back in February with an “ahah”.

    With a week to go, we might yet see her report on two suspicious characters allegedly witnessed at 18.28 in the vicinity of the Western General, one of whom was overheard referring to the other as ‘Burke’…..

    Liked by 1 person

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