Ian Dodge said NHS England should work with clinical commissioning groups to develop contract models and identify providers for such services.

He said developing out of hospital care should mean breaking down the separation between general practice and other services.

“If we spend our time looking only at what primary care currently is then we will have a problem,” he said. “The real challenge the UK faces along with all other countries is how we develop better out of hospital care.”

Mr Dodge said the proposal should not be a “national blueprint” and could not be “[imposed] rapidly across every practice”, but should be advanced as an option.

It would “enable new provider entities to provide out of hospital care which, critically, includes general practice as a core element”, he said, and would “fulfil the latent potential of the [GP] registered list”.

The services would “manage people well in the community… far more successfully than they have done hitherto”, he said.

Mr Dodge, speaking at a Cambridge Health Network event on Monday, also described the idea as a “reinvention of what a bigger version of general practice could be”.

His comments follow calls by the health secretary for general practice to be more proactive, extended, and to offer more continuity of care, with a suggestion he wants short term changes to the GP contract to aid this.

However, Mr Dodge’s suggestion is more likely to be developed as part of the primary care strategy NHS England is currently working on, and service plans due to be developed in each area with CCGs. The services would be jointly commissioned by NHS England and CCGs, and potentially also local authorities, something that has already been proposed by the national commissioning body.

Mr Dodge said commissioners should develop “a service specification of what [they] would really like to see”, which should combine both “better access and better continuity of care”.

This would “stimulate some innovative provider models. Some of them may already exist. Some of them may be new joint ventures, [or] partnerships between existing practices and other service providers.”

In relation to funding the services, Mr Dodge said: “If you were to bundle together a number of practices wanting to work as a group with some out of hospital services as well you could end up getting a much larger capitated sum.”

They could also be paid extra if use of hospital care is reduced, and for improved quality, he said.

ORIGINALLY POSTED ON THE HSJ ON 9th OCTOBER, 2013.