GP recruitment and funding at risk from delayed ICS start date

General practice recruitment and access to funding could be disrupted by confusion caused by the delayed rollout of integrated care systems (ICSs), primary care leaders have warned.

NHS logo on tiled wall
GP concerns as NHS reforms delayed (Photo: Scott Barbour/Getty Images)

Last month NHS England announced that the introduction of ICSs would be held back until 1 July 'to allow sufficient time for the remaining parliamentary stages'. They had been due to replace CCGs on 1 April, but the current statutory arrangements will now remain until the summer.

Following the delay NHS Confederation leaders say primary care providers are experiencing disruption to the support they receive from CCGs, who have been left with key posts unfilled due to the change.

NHS Confederation primary care director Ruth Rankine told GPonline that staff recruitment and access to development funding could be affected by uncertainty around commissioning and financial decions.

Integrated care systems

She added it was ‘incredibly difficult’ for primary care services to accommodate an effective transfer from CCGs when start dates 'keep shifting' - calling on the government to be 'fully transparent' about any further setbacks.

ICSs bring together NHS organisations, local authority services and other partners with the aim of better meeting the needs of patients across an area. They will align hospital services, primary care, mental health services and social care.

A DHSC white paper tabled in parliament last July set out plans for the Health and Care Bill, which will provide the legal framework for the transition. But the bill has been delayed, and only reached the committee stage in the House of Lords on 11 January.

News of a delay to put ICSs on a statutory footing was reported by HSJ as early as last November, but Ms Rankine said that official confirmation of the move has created a headache for primary care services.

Primary care commissioning

She said: ‘In many parts of the country primary care providers have strong relationships with their CCG and receive significant support. As with any transition, our primary care members are seeing disruption to that support as CCGs experience uncertainty with the shift in dates and may have key posts become vacant.

‘With everything that primary care is currently having to deliver – day-to-day business, recruitment to new roles as well as a vaccination programme – it is critical that the right support and infrastructure is there. While understandable under the current climate, delays lead to confusion about commissioning and financial decisions to enable primary care to meet contractual requirements.’

Clinicians leading COVID-19 vaccine clinics warned this month that GP partners were effectively subsidising the service, with vaccine sites half empty because of high rates of missed appointments and a slow-down in appointment bookings.

Ms Rankine added: ‘It is critical that the government is fully transparent about any further delays that might happen because it makes it incredibly difficult to plan an effective transfer from CCGs when the dates keep shifting. It makes accountability and the financial resources for primary care uncertain.’

Last November NHS chief executive Amanda Pritchard promised to embed primary care at the heart of ICS development. But LMCs have warned that family doctors need more influence over the structures - and the BMA has argued that general practice should have a 'bare minimum' of one representative per ICS.

There are now 42 ICSs covering England, each with a population of around 1m to 3m people. Each integrated care board will be required to have 10 mandatory members, one of whom must be from general practice, according to NHS England guidance published last year.

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