Midlands Hospital Trust takes over 18 GP Practices 

GPonline has reported that the Royal Wolverhampton NHS Trust, which has already taken control of 10 GP practices through its ‘vertical integration’ programme, has commenced working towards taking over a further eight.  Once the next phase of integration is complete, it is estimated that the Trust shall cover 100,000 primary care patients.

The ostensive exodus of GPs from partnership roles and the increase in locum practitioners could pave the way for hospitals trusts to expand further into primary care.  The British Medical Association (BMA) has recently warned that around 1 in 10 current GP practices could be closed by 2022.

Those GPs joining the Royal Wolverhampton NHS Trust give up their independent contractor status and become subcontracted to the Trust, with partners becoming salaried employees.

Speaking at a King’s Fund event, the Royal Wolverhampton NHS Trust integration director, Sultan Mahmud said that the vertical integration model could expand on a national basis. ‘We now have 10 practices and we’re expanding into Staffordshire and Walsall, so this is growing.’

Wolverhampton Local Medical Committee (LMC) secretary Dr Gurmit Mahay is reported to have said: ‘From an LMC perspective, it is frankly disappointing to see GPs are unable to run their own practices as they have done for over 70 years. I believe it is due to the immense pressure under which GPs perceive themselves to be working currently. The trust budget in Wolverhampton is 10 times that of primary care, and so it wields a lot of weight and can put that behind its own practices, disadvantaging the remaining practices through sheer competitive forces.’

Divisional medical director at the Royal Wolverhampton NHS Trust Dr Mona Sidhu, one of those GPs whose practice has already been taken over, said that she considered that integration was a positive move which equips GPs with the necessary resources to provide better patient care.

Speaking at the same King’s Fund event, Dr Sidhu said: ‘It wasn’t about more money in my pocket or more money from the Trust; it was purely to drive better patient care. And we wanted to remove the primary and secondary care divide… and make sure our incentives were aligned. And the only way we thought our incentives could be aligned was if we became salaried, if we gave up our independent contractor status and subcontracted our GP contracts.’

She explained that benefits of the programme, which she says has made her feel ‘empowered to do her job properly’, include reduced workload, access to HR, paid-for indemnity, unified policies and ‘robust governance processes’.

However, Dr Mahay argued that the loss of independence ‘is not good for the profession, and I think not good for the GPs in the longer run’. He said: ‘Stress can come with a relatively lower workload but when accompanied by a loss of control  – i.e. someone else deciding not only what needs to be done, but how and when.’

Darren Tamplin-Compton, Senior Solicitor and Team Leader within Fletcher’s Medical Negligence Team, said: “Whilst the perceived economies of scale and the potential attractiveness of relinquishing full responsibility of practice management may appeal to some GP partners, personally, I would prefer to continue to attend a small, well-run, community centric GP practice such as my current surgery.  Time and patient experience feedback will tell.”