Under government plans to reform the health and social care system, ICSs will take on the commissioning functions of CCGs and could pool budgets across primary and secondary care within regions.
But a report from the NHS Confederation warns that proposals to move commissioning to ICS level were leading to ‘apprehension regarding future funding for primary care’. It said a ‘lack of clarity’ around funding agreements beyond 2024 - when the current five-year GP contract deal comes to an end - was adding to these fears.
Having just one primary care representative on ICS NHS boards also risks the ‘acute voice and financial demands dominating the agenda’, the report added, as it warned funding could be taken away from primary care.
Report authors have recommended that primary care funding should be ring-fenced beyond 2024 to avoid financial risk, while ‘strong representation’ of primary care is needed at ICS board level.
The report comes just months after RCGP chair Professor Martin Marshall warned that GPs could lose influence over commissioning decisions unless they play a key role within the new management structures.
The paper, co-produced by the Confederation's PCN Network and Primary Care Federation Network, said: ‘The move to ICSs comes with uncertainty and perceived financial risk for primary care providers, especially for general practice.
‘The lack of clarity surrounding contractual arrangements beyond 2024 and the move to commissioning at ICS level is leading to apprehension regarding future funding for primary care.
Primary care networks
‘To ensure the sustainability of system working, a long-term recognition of secure funding streams needs to be identified...primary care funding [also] needs to be ring-fenced beyond the current five-year allocation.’
The report, which included data from a survey of 200 clinical directors and managers and senior GP federation leaders, found that 20% of primary care leaders cited insufficient time as a barrier to effective system engagement.
It recommended that additional funding should be granted to PCNs to enable clinical directors to ‘dedicate time for system leadership’. It also found that more than 50% of respondents were 'unclear’ or ‘very unclear’ about the role of PCNs within ICSs.
Reforms set out on 11 February by the government in a white paper titled 'Integration and Innovation: working together to improve health and social care for all' set out plans for legislation to create ICSs covering all of England.
But GP leaders have previously warned that the plans could lead to a reduction in funding for general practice - rather than an increased share of the health service budget ,which the RCGP has requested.
The BMA has also warned that GP services must not be stripped of funding - calling for ‘transparency over spending decisions’ and 'fair representation’.