LMCs demand ringfence on enhanced services cash and clear GP representation in ICSs

LMCs have called for a ringfence on enhanced services funding, along with a guarantee that GP representation on the boards of integrated care systems (ICSs) will not be capped.

GPs at an LMC conference waving green voting cards in the air
LMCs conference - this year's event has taken place online

Doctors' leaders backed a motion at the 2021 England LMCs conference - held virtually - that warned GP representation on ICS boards was ‘unclear and variable’, with inadequate advice on how LMCs will operate under the structures.

GPs said that there should be no limit on the number of GP representatives on ICS boards - with primary care dealing with the majority of patient contacts across the NHS - and argued funding was needed to backfill these staff.

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. It comes after repeated calls from GP leaders to ensure adequate representation for the profession.

ICS role

The motion, which was passed in full, also saw GPs request that any work transferred from secondary care under ICSs should be funded out of their budgets - and a call for funding for enhanced services run by general practice to be ring-fenced.

Representative for Worcestershire LMC Dr David Herold, said: ‘General practice is the cornerstone of ICSs, in a typical 24-hour period the NHS in England will see 1m patients in GP appointments. This compares with 26,000 operations in hospitals and local authorities support almost 200,000 in care homes, with more in the community.

‘GP representation should reflect this. There should be no mandated limit on the number of GP representatives. It should be for general practice to decide how it should be represented on an ICS board, and it should not be left to the whims and personalities of any other individuals.’

He added: ‘Corporate responsibility associated with these roles is considerable and the workload will not be insignificant - it’s not something that can be shoehorned into the middle of the day during surgeries. These roles need to be nationally funded at system and pace.’

Secondary care transfers

Dr Caroline Rickard argued that practices had to be adequately compensated for taking on secondary care work: ‘Where work is transferred to genre practice from other parts of the system that there is adequate consultation and that the resourcing follows the work. This will ensure sustainability of services and improve patient care.’

She added that clear guidance was needed around the role LMCs would play within the ICS structure. She said: ‘LMCs would benefit from central guidance to ICSs, who advise them of our role and our statutory duties. We are seeing a turnover of staff in our system that risks destabilising further a health and care system under significant pressure - [and] LMCs represent a welcome constant.’

LMCs are mandated to represent and negotiate on behalf of the practices in their area, and must be consulted on issues that may affect them. The role of LMCs is central to local negotiations on behalf of GPs and NHS England.

The BMA has previously argued that general practice should have a 'bare minimum' of one representative per ICS board and LMCs should have formal roles within the structures that are set to replace CCGs in April if proposed legislation is passed.

This month NHS chief executive Amanda Pritchard promised to emed primary care at the heart of ICS development, but LMCs warned that family doctors need more influence over ICSs after nine councils in the north west of England issued ‘red lines’ for future working.

Motion in full:

Agenda committee to be proposed by Worcestershire: That conference recognises that GP representation in the new Integrated Care Systems is unclear and variable and demands that GPC England negotiate with NHSEI that:

(i) all Integrated Care Systems should outline how they will enable LMCs to carry out their statutory role

(ii) there should be no mandated limit on the number of general practice representatives on both NHS and Place Boards and general practice alone should decide who represents them within an ICS

(iii) national funding for GPs roles in system and place leadership be made available

(iv) funding must be ring fenced for enhanced services that are currently commissioned from general practice through locally commissioned services

(v) where collaboration and streamlining of pathways involves work transferring to general practice from secondary care, funding and resource follows from funding previously aligned to secondary care budgets.

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