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Proposed changes in the Health and Care Bill: Impact for primary care and GPs

Proposed changes in the Health and Care Bill: Impact for primary care and GPs

GPs are stretched to the limit, experiencing pressure from escalating workloads and a shortage of staff. This may feel a difficult time to overhaul the way that the NHS runs. However, the Health and Care Bill was introduced to Parliament on 6 July, which sets out proposed NHS reforms that are likely to have a major impact on primary care.

Proposed measures in the Bill include establishing a formal role for integrated care systems (ICSs) and increasing powers for the health secretary. The details are controversial. In July, the BMA urged MPs to reject the Bill, saying the plans were poorly timed, risked NHS privatisation and failed to address funding or workforce issues.

However, it is important that GPs find time to engage with the plans and understand the implications for primary care, especially increasing collaboration and integration between services. The Bill is making its way through Parliament but implementation is intended to start in April 2022.

ICSs in the Health and Care Bill

Proposals within the Health and Care Bill focus on increasing integration, reducing bureaucracy, and increasing accountability. A BMA briefing on the implications for general practice summarises the major changes.

The key change impacting general practice is that ICSs will be established as statutory organisations while clinical commissioning groups (CCGs) will be scrapped.

Currently, the 42 ICSs in England lack legal powers. Under the new plans, ICSs will become statutory bodies with commissioning powers. Each ICS will be required to set up an Integrated Care Board (ICB), which will take on the duties and resources of CCGs, and an Integrated Care Partnership, which will have a broader focus and develop overarching ICS strategy.

Most ICS ‘places’ will align with local authority boundaries and should involve primary care providers, local authorities, providers of acute, community and mental health services as well as representatives of people who access care and support.

Role of general practice

The Bill emphasises a focus on closer collaboration and cooperation between NHS bodies and local authorities. There is little information about how GPs are expected to be involved but the changes are likely to have a major impact on general practice.

Each ICB will include one seat for a representative of general practice, out of a mandatory 10 board posts. This representative will be nominated by GPs and primary care service providers within the ICS. BMA leaders have cautioned that this one seat must be considered the ‘bare minimum’ and the ‘strong clinical voice and local expertise’ of general practice must not be lost in the transfer of power to ICSs.

Local medical committees, primary care networks (PCNs), GPs and practices will need to build new relationships within the ICSs. NHS England has emphasised that PCNs will be essential for joining up services and using their understanding of local communities to help ICSs improve health outcomes and tackle inequality.

In particular, primary care leaders will have to engage with ICBs about funding arrangements. ICBs will control NHS funding and take on existing GP contracts held by CCGs. The BMA is calling for GP funding to be safeguarded.

GPs encouraged to engage with the Bill

The Health Foundation charity recently ran a webinar: NHS reform – what do the proposals mean for general practice? Why primary care must engage with the government’s health and care reform agenda.

Overall, the webinar’s expert panel members were optimistic about improving NHS integration. However, they expressed some scepticism about how the plans would work and noted that the Bill does not deal with tough issues such as long-term strategies on the NHS workforce, health inequalities and social care.

Speaking in the webinar, Professor Martin Marshall, chair of the Royal College of General Practitioners (RCGP), was positive, saying: “Never has there been a better time to address the fragmentation between hospitals and community silos”. But, recognising that many GPs are currently in ‘survival mode’, he cautioned: “If general practice doesn’t engage with this, then it won’t work.”

General practice needs a strong voice

The webinar speakers agreed that general practice needs to develop a strong voice in ICSs and collaborate closely with other organisations, but investment in GP leadership and support will be vital to achieve this. The RCGP has said it wants to see ‘legislation and guidelines to embed a strong GP voice at all levels of ICSs’.

General practice is already moving towards greater integration, more multidisciplinary collaboration and better use of technology. ICSs have potential to facilitate these trends. As Professor Martin Marshall concluded, “This is about having a vision of where general practice is going, and really enabling that, and leading that with enthusiasm because general practice is so important.”

Medical Defense Society is available 24/7 to provide medico-legal support for members.

Advice for locum GPs – How to access the Welsh state-backed indemnity scheme

Advice for locum GPs – How to access the Welsh state-backed indemnity scheme

Since 2019, GPs providing NHS services in England and Wales have been automatically covered against clinical negligence claims by state-backed indemnity schemes. However, from December 2020, locum GPs working in Wales have been required to sign up to the Locum Hub Wales staff ‘bank’ to access the scheme.

While the introduction of this new requirement has been controversial, the Welsh government reports positive feedback from GP practices and locums using the system.

Requirements to access the state-backed indemnity scheme for locum GPs in Wales

GPs working in Wales receive indemnity through a General Medical Practice Indemnity (GMPI) scheme. This is managed by the Legal and Risk Services team at the NHS Wales Shared Services Partnership (NWSSP). Cover applies to claims arising from incidents occurring on or after 1 April 2019, when the scheme was introduced. The BMA provides further information about what the scheme covers.

If you are a GP locum working for a GP practice in Wales, you have to be listed on the All Wales Locum Register (AWLR) to access this state-backed indemnity scheme. To be included on the AWLR, you must be a qualified General Medical Practitioner on a Medical Performers List in Wales.

From December 2020, an additional requirement to qualify for cover is that your locum GP shifts are booked or recorded through Locum Hub Wales (LHW).

NWSSP provides GMPI guidelines along with a list of FAQs. If you want to access the GMPI scheme, contact the Employment Services Division of NWSSP for advice on the application process (contact details here).

Locum Hub Wales

At a time when rising workload pressures and a shortage of GPs in primary care are leading to increased reliance on use of locums across the UK, tools are needed to manage the locum workforce. LHW was designed to be a free, online tool making it easier for locums to find work and for practices in Wales to fill their shifts.

But registering with LHW has now become a requirement if you want to benefit from GMPI as a GP locum working in Wales. To qualify, you must complete a locum profile on LHW and enter information about each locum shift you provide.

GPs and the BMA’s GP Committee for Wales have lodged ‘strong concerns’ about the new requirement, particularly that the system is unnecessarily burdensome and open to administrative error, so that locums may not be able to prove they had indemnity cover and become liable for clinical negligence costs.

Some GPs have been worried about a negative financial impact on both locums and GP practices in Wales. Locums in Wales are reportedly raising fees to pay for additional indemnity cover due to a lack of confidence in the system and some are even avoiding working in Wales.

However, a Welsh Government spokesperson said: “Since the release of the full functionality of Locum Hub Wales, NWSSP has received positive feedback from both practices and locums using the system, including noting an increase in choice within their area.”

Opting out

If you decide not to sign up to AWLR and LHW, you will be responsible  for  arranging  your  own clinical  negligence  indemnity  cover  for  any  locum  shifts  worked  in Wales in general practice. You will also need to notify the Health Board, NWSSP Employment Services and the GP practice that you have arranged your own indemnity cover.

Ensuring adequate indemnity for work not covered by the state-backed scheme

GMC advises considering whether you need to take out additional professional insurance or indemnity for work that is not covered by the state-backed scheme and to access personal regulatory and medico-legal support and advice.

Activities and services not covered by GMPI include non-NHS or private work, chargeable services such as medicals, reports and statements, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities.

If you are a GP locum in Wales and unsure whether your current indemnity arrangements are adequate and appropriate, please contact us for advice at Medical Defense Society.