'No way back' for practices that join integrated care provider, warns BMA

Practices that 'suspend' their contract to join an integrated care provider (ICP) are unlikely ever to be able to return to their former GMS/PMS arrangements, the BMA has warned.

GPC chair Dr Richard Vautrey (Photo: BMA)
GPC chair Dr Richard Vautrey (Photo: BMA)

The warning followed publication of the ICP contract by NHS England and accompanying documents that set out how GPs could participate in ICPs. The contract has been developed following a consultation process and NHS England said it would be made available from 2019 'in a controlled and incremental way'.

ICP contracts are described in the NHS long-term plan as allowing 'for the first time the contractual integration of primary medical services with other services, and create greater flexibility to achieve full integration of care'.

NHS England has set out two ways in which practices can join ICPs. A ‘partially integrated’ ICP would see practices retain their current GMS or PMS contract and funding arrangements, signing an ‘integration agreement’ with the ICP to set out how the two parties would work closely together.

ICP contracts

Under a ‘fully integrated’ ICP, practices would choose to terminate or ‘suspend’ their contract and staff would either become employees of the ICP or the practice could continue as an independent entity but as a subcontractor of the ICP.

NHS England said that it expects the partially-integrated ICP ‘to be the most likely route chosen by participating practices’. However, in a separate document it said that it understood some CCGs were ‘considering a scenario where they will have some practices opting to relate in a partially-integrated way, and some in a fully-integrated way’.       

GPC chair Dr Richard Vautrey said the BMA had consistently warned practices of the ‘serious risks’ of engaging in an ICP contract. He said that by becoming part of the contract, practices would be ’putting their future at risk’.

‘Practices should not even consider the option of reactivating their contract if it all goes wrong in an ICP as a realistic possibility,' Dr Vautrey said. 'The likelihood of that being practically possible once staff have moved on is remote. Going into an ICP should be seen as a once and for all event.

Loss of control

‘Practices would also run the risk of losing control of the service that they deliver to their local community and potentially laying themselves open to take over by private companies.'

Dr Vautrey also cautioned practices against the partially integrated ICP arrangement. 'We see this as a slippery slope to losing control of the practice, with loss of core funding to the ICP, with little if any benefit compared with the way of working within a primary care network (PCN).'

If a practice decided to suspend its contract and fully join the ICP, existing GMS/PMS requirements and all associated funding would become part of the new ICP contract. Practices would have the right to 'reactivate’ their GMS/PMS contract at two-year intervals, according to NHS England.

If a practice reactivated its contract after two years, patients who had previously been on its list would return to the practice. If the practice decided to pull out any later than this then the patients would remain with the ICP, unless they chose to re-register with the practice.

Contract 'reactivation'

NHS England acknowledged that there were ‘limits as to what can be nationally guaranteed on reactivation’. It highlighted issues around transferring staff back to the practice and any arrangements relating to premises that were agreed when the practice entered the ICP as potential problems for practices that wanted to leave the ICP.

Dr Vautrey said practices should focus on developing PCNs as a way of providing more integrated care rather than signing up to ICPs.

‘PCNs build on the GMS contract and leave GPs as independent practitioners who are able to set and lead their agenda and advocate for their patients in ways they would not be able to do as employed doctors,’ he said.

NHS England has said that ‘local ICP proposals will not be able to move forward without support from general practice’. GP involvement with an ICP is voluntary, although BMA leaders have raised concerns that practices could face pressure to join as integrated care arrangements take shape under the five-year contract that took effect earlier this year.

Integrated care systems, which are set to cover England by April 2021, aim to establish collaboration across the NHS, social services and voluntary providers - although without the need for contractual changes required for the formation of ICPs.

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