And now… another big proposal for NHS reform
GPs should be given more powers to coordinate care in the NHS, a think-tank is suggesting, in what would be yet another upheaval of the health service.
After the early years of the coalition government were overshadowed by changes which gave GPs more commissioning powers, the King's Fund has now said more reforms are needed to help the NHS cope with Britain's ageing population.
It is proposing 'family care networks' centred around GP surgeries doing more as providers as well as coordinating care.
The attempt to move care delivery closer to people's homes could be backed by Labour, which is seeking to foster closer relationships between public service users and those providing them.
King's Fund chief executive Chris Ham said: "This new funding and commissioning model for primary care could offer GPs an important opportunity to lead the way in finding new and innovative ways of working.
"At a time when NHS budgets are increasingly under pressure and the proportion spent on general practice is in decline, these proposals could bring money into general practice if GPs take responsibility for providing and co-ordinating a wider range of services.
"GPs are well placed to do this because of the registered lists of patients, but it would also be possible for trusts providing hospital and community-based services to take on the leadership role, working with GPs as partners."
Under the new contract being proposed by the report, GPs would require practices to link up with others in the NHS to work at the most effective scale – and benefit from pooled expertise in the process.
The changes would attempt to set aside the old debate between the relative merits of public- and private-sector approaches by focusing on outcomes rather than delivery methods.
They would also attempt to proactively manage the health of their local population, making it easier for them to assist patients in a health crisis.
"Our research with GP practices that are already starting to work in this way showed that to improve the quality of patient care you needed to 'win over the hearts and minds' of GPs and local providers," King's Fund senior fellow Rachael Aldicott said.
"A significant investment in people and in leadership and organisational development is a must if the new family care networks are to have the capabilities they need to succeed."
The Department for Health said it was introducing pooled budgets in every area from 2015/16, bringing £3.8 billion of health and social care funding together.
But it stopped short of backing the King's Fund ideas completely.
A spokesperson said: "With an ageing population we need to be looking after people much better out of hospitals and focusing more on prevention as well as cure.
"That's why we are putting GPs at the heart of a more personalised proactive system of care based in the community, encouraging GP services to stay open for longer and are in the process of bringing NHS and social care together to form a single seamless service for the elderly and most vulnerable."
The government's plan for vulnerable older people, which officials say will set out a vision for improved out-of-hospital care to keep people well and independent for longer, is expected to be published later this year.