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.”
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