The tectonic plates of primary care appear to be shifting. In April 2016, Scotland abandoned the Quality and Outcomes Framework (QOF). Then, in October 2016, NHS Chief Executive Simon Stevens gave more than a hint that a similar fate awaits QOF in England. Meanwhile, Wales and Northern Ireland continue with the scheme — for now.
Wider changes are afoot. The Five Year Forward View (5YFV) has trailed the formation of two radically changed models of primary care, termed Multi-Specialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS).1 In the first, federations of GPs will form single community organisations, joining forces with mental health and social care, maximising the amount of out-of-hospital care. The alternative PACS model is a form of vertical integration with either primary or secondary care taking the lead in linking hospital services with community and mental health services. Both ‘new care models’ are likely to have substantial funding implications for GPs. Equally far reaching is the constraint provided by the 5YFV on the Department of Health, ensuring that in future only arrangements aligned to the delivery of 5YFV objectives will be supported.
In Manchester, ‘Devo Manc’ became the first national example of a local authority taking control of its health and social care budget. The vision was to achieve ‘the greatest and fastest improvement to the health and wellbeing of the people of Manchester’.2 In April 2016, 12 clinical commissioning groups (CCGs) and 15 foundation trusts or trusts joined together to provide health care. In practice, this model of devolution is likely to hand a greater say to local authorities in the commissioning of GP services. Again, the funding implications for GPs are unclear at this stage but are likely to be substantial.
Meanwhile, in Scotland, the changes involve the complete dismantlement …