NHS England to ‘engage’ with public on effects of digital-first primary care

NHS England is to engage with the public, primary care professionals and innovators on how the health service can ensure the GP payment system is “fair” in light of increasing digitisation.

Speaking at NHS England’s latest board meeting on 4 July, Ian Dodge – national director of strategy and innovation – presented a paper which looked into the possibility of a ‘number of adjustments’ to the NHS’s GP payment system.

The report states that one of the challenges facing the primary care payment system is ensuring that it “keeps up with the opportunities digital innovations offers”.

Dodge told board members that the system also needs to be “fair”.

One example cited in the paper is the roll out of GP at Hand, which is offered by a practice in Hammersmith and so paid for by Hammersmith and Fulham CCG.

List sizes at the practice have grown hugely following the launch of the service, leaving the CCG facing additional costs of up to £10.6 million. The paper argues this shows the current payment “was not designed with these models in mind”, which has led concerns being raised about the “sustainability of wider primary care systems in the face of such change”.

The paper adds: “There is disquiet in some quarters that digital-first models could result in ‘cream skimming’ by which providers attract or select less complex patients, and that they could thereby benefit from an over-generous share of GP funding, leaving other practices relatively underfunded for the workload associated with their remaining patients.”

Following analysis carried out by NHS England, the national body suggests there are a number of ways in which the payments for general practice may need to be updated in order to allow for technological innovations.

These suggestions are related to:

• The rurality index payment
• The London adjustment
• A reduction in the payment to practices for patients who live outside of the practice catchment area

NHS England now wants to hear feedback from the public, primary care professionals and digital innovators as part of an ‘engagement process’.

Particpants are being asked on a number of issues relating to innovation within the NHS and how general practice payment models.

The consultation is open until 31 August 2018.

Dodge concluded his presentation to NHS England board members by saying the process was “the first step”, adding that his team “fully acknowledge that we don’t have the full answers yet”.

He said the engagement process will also call for “more intensive joint working between NHS England and our partners, particularly the British Medical Association (BMA)”.

Richard Vautrey, GP committee chair of the BMA, said: “In the year the health service turns 70, we need to take serious steps to address the fundamental issues facing general practice, from workload and workforce pressures to unsustainable indemnity costs and problems with premises. NHS England’s commitment to work with us to address these and other issues which we have repeatedly highlighted is welcome.

“And while the BMA recognises the many advantages that technology and innovation can provide for general practice, it is important that the implications of its implementation are carefully considered. We welcome the move from NHS England to engage on how this is best achieved.”