Crisis talks as practices consider switch to 'dangerous' ICP contract

GP leaders in London are holding crisis talks with practices that are considering abandoning GMS contracts to join large-scale integrated care provider (ICP) deals.

Contract (Photo: Rob Daly/Getty Images)
Contract (Photo: Rob Daly/Getty Images)

‘At least five’ practices in the London borough of Tower Hamlets are in discussions about giving up their GMS contracts for ICP contracts, LMC leaders have told GPonline.

But senior GPs fear the 'dangerous' move could undermine general practice in the area and open the door to privatisation.

ICP contracts are described in the NHS long-term plan as allowing 'for the first time the contractual integration of primary medical services with other services’, creating ‘greater flexibility to achieve full integration of care'.

The government has said GPs will not be forced to switch contracts to join an ICP, but GP leaders fear practices could come under pressure to do so as integrated care arrangements take shape under the NHS long-term plan. GPs also fear that existing financial pressures could push desperate practices to consider abandoning GMS contracts.

Informing practices

Speaking at the UK LMCs conference last week, Tower Hamlets GP and LMC member Dr Naomi Beer urged the GPC to ‘do even more’ to get information out to practices about the ‘very real dangers of ICPs’.

‘No one knows better than you that practices are feeling extremely vulnerable despite the successes of new contract,’ she told GPC officials. ‘What you may not yet have grasped is the extent to which practices are so unnerved that they are exploring many disparate avenues in their efforts to stay alive, some of which involve giving up their GMS contracts and moving to an ICP even in Tower Hamlets.

‘In Tower Hamlets we know of at least five practices engaged in such discussions and we’re in great danger of this divide and rule, fragmenting our services and upsetting the quality of provision to patients.’

Tower Hamlets LMC chair Dr Jackie Applebee confirmed to GPonline that there are practices ‘looking at things outside their GMS contract, which we’re very worried about’.

‘I’m rather hoping that we can persuade them not to,’ she added. ‘I think [the practices] think they’re going to get more funding through an ICP contract but what they don’t seem to appreciate is that there’s no guarantees for that and also I think they haven’t really looked at the long-term consequences of it. They might have jam today but you know it’s going to be bread and scrape tomorrow.’

ICPs & vertical integration

Dr Applebee also confirmed that some Tower Hamlets practices were considering ‘vertical integration’ with a trust - a model that has already seen the Royal Wolverhampton NHS Trust take control of 10 GP practices in the West Midlands, with a further eight to be added in due course.

She said that it still ‘wasn’t clear’ which organisations the practices in question were looking to integrate with to form an ICP or vertical integration, but gave Barts Health - an NHS trust which operates five hospitals across central and East London - as a potential example.

‘I would be really concerned about that because secondary care providers do not have a great track record of running general practice and they don’t necessarily understand general practice. They are so strapped for cash themselves that I can see that general practice might end up being worse off.’

NHS privatisation

GPC chair Dr Richard Vautrey told the conference of England LMCs in November that ‘the threat of so-called integrated care providers (ICP) - which is a resprayed accountable care organisation - is real and should not be underestimated.

‘Be under no illusions, entering in to an ICP agreement is a one-way street to loss of independence, direct management control and potential wholesale privatisation. It would bring to an end 70 years of NHS general practice that our patients value so highly and it would be an end to the partnership model of working.’

Dr Applebee echoed these concerns, saying she was ‘very worried’ that practices could be ‘sleepwalking’ into privatisation via ICP contracts.

She said that Tower Hamlets LMC was going to ‘talk to the CCG fairly imminently’ and have ‘private conversations with the practices’ alongside a Tower Hamlets wide meeting ‘just thrash it out - because it affects everybody, the whole health economy.’

Londonwide LMCs chief executive Dr Michelle Drage added: ‘We have serious concerns about practices giving up part or all of their GMS, PMS or APMS contract by entering into an ICP. We recognise the value of collaboration and co-ordination of services, but primary care networks (PCNs) are the best way forward for this. Integrated care systems may work if organised to support PCNs, but ICP contracts should be avoided at all costs.’

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