Following the publication of her primary care stocktake report, GP and ICS executive Claire Fuller speaks to Healthcare Leader on the end of clinical commissioning groups (CCGs) and the challenges facing primary care in their absence.
Her report offers a series of sweeping recommendations to improve the way ICSs and primary care work together, in particular urging NHS England to work on the commissioning and funding framework to ‘enable and support new models of integrated primary care’.
The report suggests transformation of primary care should be led by ‘integrated neighbourhood teams’, equipped to develop a ‘collaborative multiprofessional workforce’.
This comes a month before Integrated Care Boards (ICBs) formally take over commissioning responsibilities from clinical commissioning groups (CCGs), from 1 July.
Is it right that CCGs come to an end?
Claire Fuller: The ICS takes on many of the functions of a CCG, but the thing that is different about them is that they work across the broader partnership: CCGs are just about the NHS, while ICSs are about partnership.
That’s reflected in these neighbourhood teams. These teams are really important for prevention work.
That’s why the move to the ICS is so important, and in particular the Integrated Care Partnership Board, which has got that local authority partnership and the voluntary sector partnership, working in many places with universities.
We want to have all of those people in the room at the same time to have a proper conversation about people’s lives and how we fix it.
How will primary care fare under ICBs?
CF: One of our recommendations is that under each ICB, there will be a primary care network that includes all bits of the profession, so not just general practice, but dentists and pharmacists. Given that we’ve got a letter signed by all 42 ICSs committed to implementing the stocktake, I would say it has never looked better for primary care.
What would you say are the risks to primary care under the new system?
CF: One of the big risks we’ve got at the moment is that over the last six months we have heard fantastic stories and we have seen so much enthusiasm.
We have got real interest nationally; we’ve got real interest at system level. We’ve got people really understanding the importance of primary care, I think for the first time.
We need to keep that momentum going. We need to keep that enthusiasm going. I think the risk is we are all really tired, but we need to keep that dialogue going.
That positivity is the thing that will actually continue to get our voices heard at the top table and with the national team. I think how this report is perceived by the profession is really important.
A major concern is that primary care will not be represented well enough on ICBs. What are your thoughts on this?
CF: There’s a recommendation in the report that talks about having a primary care board that sits underneath the ICB.
On our board, I’ve only got one acute trust seat. At the moment, I’ve got the primary care leader; I’ve also got two CMOs – one from a primary care background; I’m a GP.
That clinical voice is still incredibly important. And again, all 42 signed a letter saying primary care is really important to them and a priority. That is the most powerful thing about this.
What can the new system learn from what CCGs achieved?
CF: CCGs really did give general practice a voice for the first time properly. I think it gave many of us real leadership opportunities: you look around at those of us in real senior leadership position and we’ve all come up through the CCG route.
You’ve got Amanda Doyle, now in her new role. You’ve got Ursula Montgomery and her role. There’s been a generation of GP leaders.
We’ve now got to make sure we’ve got the right leadership infrastructure, because we haven’t got that obvious route through for people to come through. And it’s really important that we keep on getting the GP and primary care voice heard nationally; heard at system level, and heard as an equal with the other areas of the NHS.
Dr Fuller’s report, commissioned by NHS England and published last week, warned that investing in PCN leadership will be the ‘difference between success and failure’ in integrating primary care.