Primary care’s representation on integrated care boards (ICBs) is still not strong enough, health leaders have told the House of Lords.
The Lords also heard that the lack of a mandate for devolved primary care representation has limited how well the new systems can help primary care recover.
It comes as part of the House of Lords Integration of Primary and Community Care Committee’s panel as to how ICBs should best use pharmacy, optometry and dentistry services to reduce the pressure on GP surgeries and hospitals.
ICBs last month assumed responsibility for commissioning the three pillars of primary care.
During the panel on Monday (15 May), Daniel Hardiman-McCartney MBE, lead clinical adviser at The College of Optometrists, said: ‘There is huge potential for greater integration with ICBs but what we’ve seen in optometry is very fragmented and uneven.
‘The straightforward representation of primary care as a whole is not necessarily strong in all areas. We’re concerned that actually having just one person at the ICB who represents all of primary care is not a very good way for us to add voice and evidence, build pathways, help with scalability or share what’s happening.’
Ewan Maule, lead pharmacist for North East and North Cumbria ICS and a board member for the Royal Pharmaceutical Society’s English Pharmacy Board, suggested this is in part down to ICBs being formed from clinical commissioning group (CCG), which commissioned general practice but not the other services.
He said: ‘The shift towards recognising the needs of the rest of primary care is a very significant shift.’
He added that pressure on running costs has made it much harder to develop opportunities for multidisciplinary clinical leadership.
Pharmacy’s inherent close proximity to general practice has allowed it to integrate more easily, despite the lack of a mandate, he suggested.
‘Most if not all ICBs will have someone in a role similar to myself – either a director level or a chief pharmacist level – but that wasn’t mandated anywhere. That has emerged because people have recognised over time that that was essential.
‘If pharmacy is not being recognised as essential from the outset of ICBs then I can understand why colleagues in optometry and dentistry, who historically haven’t been as close to general practice, have found it really difficult to influence the direction of the ICB.’