Thread by @nedwards_1

Some thoughts on ideas on GP ‘nationalisation’ to reduce hospital admission floated by @sajidjavid and reported by @Smyth_Chris 1/10

TL;DR The evidence to support this proposal is poor

Framing the goal of GP as being about reducing admissions represents a serious misunderstanding of the role of primary care. Better GP can reduce admission to hospital but defining its purpose as doing this misses its much wider role. 2/10

Ambulatory care sensitive conditions are not the main driver of hospital admission nuffieldtrust.org.uk/resource/poten… 3/10

The UK seems to have a lot of potentially preventable admissions but access to home and intermediate care as well community diagnostics seem to be higher on the list than problems with GP 4/10

Really good long term condition / population health management can help reduce admissions but there is no reason to suppose this is related to ownership models. Continuity, systematic PHM and resources more likely to matter 5/10 See @SteveLaitner for more

Evidence from USA ACOs is that those based on hospitals rather than physician groups did less well in reducing hospital use. All the integrated models had very mixed results in this area. 6/10 ajmc.com/view/accountab…

Moving from contracting to ownership may improve standardisation but could impact on GP willingness to go beyond contractual requirements. What might be gained in efficiency could be lost through less discretionary effort 7/10

Developing well organised and professionally managed primary care organisations is probably a good route to improve care, reduce hospital use and creating rewarding jobs but hospital ownership is only one route to this and it won’t be the best one in many cases. 8/10

Generalising from the particular circumstances in Wolverhampton not likely to be a good idea as a national template 9/10

Reviews are fine – but, fixing the workforce and dealing with the current pressures might be better 10/10