Just one seat on each NHS integrated care system board will represent GPs

Representatives of general practice will hold just one out of 10 seats in total on the board of each of England's integrated care systems (ICS), NHS England has confirmed.

Integrated care system guidance (Photo: In Pictures Ltd/Corbis/Getty Images)
Integrated care system guidance (Photo: In Pictures Ltd/Corbis/Getty Images)

Guidance published on 16 June states that one person representing general practice from within the area of the ICS body will sit on each board, which requires 10 mandatory members.

However, the BMA has said this is the 'bare minimum' that the NHS could have done to ensure general practice representation at board level - and has argued that formal roles should be given to LMCs.

A minimum of four executive members employed by the body will be required to sit on the boards, including a chief executive, a finance director, a director of nursing and a medical director.

Integrated care systems

The ICS will also need to have three independent non-executives composed of a chair and at least two others who will ‘normally not hold positions or offices in other health and care organisations within the ICS footprint’.

A further three ‘partner members’ are required, including one from general practice, one from an NHS trust or foundation and another from a local authority. But the guidance clarifies that these members will ‘not be acting as delegates’ of their sectors.

ICS NHS bodies will be allowed to add to the mandatory positions as they develop, however, those joining boards will be subject to agreement with NHS England and NHS Improvement (NHSE&I).

It adds that boards will ‘need to be of an appropriate size to allow effective decision making to take place’ - and should ensure that they ‘take into account the perspectives and expertise of all relevant partners.’

Primary care role

Those sitting on boards are advised that primary care should be ‘represented and involved in decision-making at all levels of the ICS’, including strategic decision-making forums at place and system level.

They are also encouraged to consider the support PCN clinical directors may need to develop primary care and help transform community-based services.

Reacting to the guidance, a BMA spokesperson said: 'The BMA has always been clear that in the move away from CCGs towards ICSs, that the positive functions of CCGs – namely the strong clinical voice and local expertise – should not be lost.

'To see this framework include at least one general practice seat at board level is therefore positive, however, it should be noted that this is a bare minimum, and we believe that ICSs must go beyond this to ensure that clinical representation, leadership, and engagement are embedded throughout their structures.

General practice funding

'In doing so, as we have said before, ICSs should include formal roles for LMCs representing primary care, local negotiating committees for secondary care, and public health doctors.'

The guidance also confirmed that all CCG functions and duties will be transferred to ICS bodies, along with all CCG assets and liabilities, including their commissioning responsibilities and contracts.

A white paper published by the government in February outlined proposals to bring the NHS and local government together legally in ICSs - scrapping CCGs.

However, GP leaders have warned that general practice will need a 'strong voice' within ICSs as they take over CCG budgets and commissioning powers, or lose out on funding.

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