GPs need 'strong voice' in NHS after white paper reforms, warns RCGP

GPs must have a 'strong voice' within integrated care systems (ICSs) as they take over CCG budgets and commissioning powers under NHS reforms unveiled by the government, the RCGP has warned.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)

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.

There are currently 41 ICS or strategic health partnership areas across England - but these are currently not underpinned by legislation to allow formal collaboration between providers and CCGs.

Plans set out in the white paper - which forms the basis for a health bill that will go through parliament later this year - propose 'a statutory ICS in each ICS area'. The whiite paper says: 'These will be made up of an ICS NHS Body and a separate ICS Health and Care Partnership, bringing together the NHS, local government and partners.

NHS white paper

'The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems' health, public health, and social care needs.'

CCGs will 'become part of ICSs' and the 'ICS NHS Body' in each area 'will take on the commissioning functions of the CCGs and some of those of NHS England within its boundaries'.

Speaking at the online RCGP conference 'A Fresh Approach to General Practice', college chair Professor Martin Marshall said there was a 'real opportunity' in the white paper plans as long as GPs were able to secure influence at the top of ICSs.

'We know internationally the most integrated health systems round the world are the ones led from and by primary care,' Professor Marshall said. 'So if general practice doesn’t have a strong voice in these new integrated care systems that’s going to be a massive problem.

GP voice

'My understanding on early work on the health bill that could be going through parliament from May is that there is a suggestion that there should be a strong general practice voice at the top of the integrated care organisations, which I think is positive. We need to really push hard for that at every local level to ensure we have that loud voice.'

The white paper confirms that each ICS NHS Body will have responsibility for 'developing a plan to meet the health needs of the population within their defined geography', developing a capital plan for NHS providers in the area, and 'securing the provision of health services' to meet patients' needs.

These organisations will 'merge some of the functions currently being fulfilled by non-statutory STPs/ICSs with the functions of a CCG', and bring the 'allocative functions of CCGs into the ICS NHS Body'.

Rules to be set out in the forthcoming health bill could create mechanisms for NHS providers to form committees that sit alongside the ICS structures in their area. Primary care networks, GP practices, community health providers, local authorities and the voluntary sector could be represented within both, the white paper says.

The BMA has hit out at the timing of the white paper, warning that 'sweeping' reforms to the NHS must not be rushed through at a time when the health service is struggling to cope with the COVID-19 pandemic.

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