Meeting papers from the end of last month reveal that local authorities in Cheshire and Merseyside outlined a list of ‘red lines’ to ensure ‘successful’ ICS working between themselves, health services and other providers.
The document states that NHS spending in each area ‘should be determined in partnership with local government’, and that ICS place-lead roles should be jointly appointed with councils.
It adds that ‘funding allocations to places and providers should be transparent, fair, and subject to local democratic challenge’, while a ‘range of NHS services should be guaranteed to all communities.’
The white paper published ahead of the Health and Care Bill, which sets out the legal framework for making ICSs statutory bodies that will replace CCGs, has suggested that ICS 'places' will normally align with local authority boundaries.
Integrated care systems
But an LMC in the area has warned that overly aggressive moves to ‘put a mark down’ could lead to a bun fight for influence within the structures.
Meanwhile, the RCGP has said it wants to see 'legislation and guidelines' to embed a strong GP voice at all levels of ICSs – warning that influence could be ‘unfairly concentrated’ if not.
In the letter, the councils said that partnerships between themselves and GPs, including through primary care networks, should be strengthened to form care communities, with the aim of addressing ‘diverse health needs’ in the area.
But Liverpool LMC medical secretary Dr Rob Barnett suggested that moves to assert power could damage relationships and that the voice of GPs could be lost under current plans that would see just one GP representative on the board of ICSs.
Primary care voice
Dr Barnett said: ‘I would be interested to know who actually has driven this - I think it's miraculous that they have managed to get all the local authorities to agree to something. I suppose they're trying to put a mark down, and I think lots of people will be trying to do things like that.
‘At place level there may be a good argument for local authority involvement, but we need to make sure that there's adequate GP involvement at that level too. I think at the ICS level, I do think that local authorities are likely to drown out GPs.
NHS England guidance published in June revealed that a representative from general practice will hold just one out of 10 seats on the board of each of England's ICSs. The BMA has previously said that one GP member is the 'bare minimum' that should be on ICS boards - and has argued that formal roles should be given to LMCs.
Dr Barnett told GPonline: ‘I think there is general concern that general practice is losing its voice. So when you think about the involvement within CCGs, I would say it's a retrograde step to end up with just one GP sitting on the NHS ICS body.’
RCGP vice chair Dr Gary Howsam said it was 'crucial that primary care has an influential voice in ICSs'.
'[The college] would like to see legislation and guidelines to embed a strong GP voice at all levels of ICSs, Dr Howsam said. 'We also realise that for ICSs to be successful for their local areas and populations, a range of partners from across health and care systems need to be part of strong collaborative relationships.
‘The current guidelines for at least one member from primary, secondary, and local government means there is a degree of parity between the three areas at the integrated care board level. However, there is still much to be decided about how the integrated care board and the health and care partnership board will work together for their patients.
‘It is possible in any system that influence may be unfairly concentrated within a small number of organisations, in a way that is not conducive to building collaborative relationships across providers.This might result in the GP voice being less influential at the highest level of an ICS, or indeed the local government voice, which would hamper progress to a truly integrated system.’
He added: ‘More must be done to bring clarity to how collaboration will be prioritised in order to ensure ICSs consider the voices of all partners in the best interest of both patients and wider local health and social care.’
RCGP chair Professor Martin Marshall has previously insisted that general practice must be the 'foundation of any ICS' to ensure that GP teams and the wider NHS are best enabled to deliver care to patients.
BMA deputy chair and Lancashire GP Dr David Wrigley, said: '[The BMA has] previously raised concerns over the impact of ICSs on the delivery of care in regions across the country and the need for proper representative engagement at all levels to ensure they work effectively.
'It is understandable that local councils, like many other organisations and bodies that will be directly impacted by ICSs, should express their own concerns about proposed changes. The success of If ICSs are to work then it will be down to effective collaboration from all parties involved.
'It is absolutely crucial throughout any changes that core GP funding is protected, including core GMS and PMS contract funding, as well as locally agreed arrangements such as those between GP practices and CCGs. These locally agreed services are often vital to patient care in a particular locality.
'With the largest ever backlog of patient care to contend with, we need effective clinical engagement and leadership on this issue, and at every level of all care sectors within ICSs, to ensure patient care is absolutely front and centre of any proposed changes.
Last month BMA leaders urged MPs to reject the government's Health and Care Bill saying the plans were poorly timed, increase the risk of NHS privatisation and fail to tackle funding or workforce shortages.