NHS reforms threaten 'clinical voice' at critical time for GPs, warns RCGP

The voice of GPs will be ‘diminished’ under government plans to reform the NHS and could jeopardise the future success of the health and social care system, the RCGP chair has warned.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)

Giving evidence to MPs, Professor Martin Marshall said that the NHS would lose the expertise of ‘a lot of experienced’ clinical leaders when CCGs are scrapped and integrated care systems (ICSs) become statutory bodies in April 2022 under reforms in the Health and Care Bill.

Professor Marshall, who said GP morale was ‘at rock bottom’, argued that family doctors were well placed to represent primary care services on ICS boards because of the variety of professionals they work with in multidisciplinary teams.

He added that the 'marked workforce crisis’ within general practice, and more generally within the NHS, could prevent ICSs from achieving their full potential - adding it was the worst possible time for reform to take place for GPs.

Integrated care systems

Officials confirmed in June that only one seat on each ICS board will represent general practice out of a mandatory 10 board posts in each of the organisations. However, the BMA argued that this was the ‘bare minimum’ and warned ‘local expertise’ must not be lost.

Speaking at a health and social care select committee meeting on 9 September, Professor Marshall said that a lack of primary care representation on ICS boards was one of the college’s biggest concerns with the bill.

He said: ‘The general practice voice threatens to be diminished as a consequence of the change in legislation around CCGs [which are] going to disappear. We're not necessarily saying that's the wrong thing, but it means that a lot of the experienced clinical leaders in CCGs risk getting lost.

‘Leaders who have been around for a decade or two, who understand the nature of organisational change and what the bill is trying to achieve - there's a real risk that they'll get lost. And we know from the evidence that the most successful integrated care organisations around the world are the ones that are primary care-led. So if primary care doesn't have a dominant voice, then the ICS is much less likely to achieve the potential.’

GP morale

Professor Marshall added that a ‘strong GP voice’ could turn a ‘fragmented service’ into an integrated one, focused on preventing diseases rather than treating them. But he warned that dwindling GP numbers and morale risked the success of the bill.

He said: ‘There couldn’t be a worse time for general practice to introduce this bill… but it’s got to happen now - the NHS is ready for it. The fact that general practice doesn't have the capacity or capability to engage fully with the implications of the bill will mean that the bill won’t realise its full potential.’

The RCGP previously warned that general practice must be the 'foundation of any successful ICS', arguing it was the only way to ensure that GPs, their teams and the wider NHS are best enabled to deliver patient care.

In July the government presented its NHs reform bill to parliament, setting out major changes that include scrapping CCGs, formalising the role of integrated care systems and increased powers for the health secretary.

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