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More must be done to prevent ‘tokenistic’ GP representation on ICSs, GP leaders warn


By Costanza Pearce
27 May 2021

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Leaders of PCNs and GP federations have warned that more must be done to prevent ‘tokenistic’ GP representation on ICSs, according to a new report by the NHS Confederation.

The NHS Confederation PCN Network and Primary Care Federation Network surveyed more than 200 PCN clinical directors and managers and senior GP federation leaders on recent plans to transfer CCG commissioning powers to ICSs from 2022.

It found a ‘lack of transparency on the role of PCNs’ in the new ICSs, with more than 50% of primary care leaders saying they are ‘unclear’ or ‘very unclear’ about their role, the NHS Confederation said.

The report set out five ‘key requirements’, including ‘collective voice and representation for primary care at system level’ – such as ICS boards.

It said: ‘Guidance will need to do more to prevent a tokenistic offer of representation and instead show an understanding of what primary care offers the system. 

‘We need to create an expectation on systems so primary care is represented fairly and equally in discussions, decisions, partnerships and governance structures at all levels as ICSs develop.’

Only 12% of respondents said they were ‘always involved in discussions at system level’, the report added.

It also called for ‘additional funding’ to ‘enable PCN clinical directors and other primary care leaders to dedicate time for system leadership’, with 20% of survey respondents citing ‘insufficient time as a barrier to effective system engagement’.

Meanwhile, the report added that the ICS plans create financial ‘uncertainty’ for GP practices and called for ‘ring-fenced’ funding beyond the five-year GP contract.

There is a ‘risk [of] funding shifting from primary care to secondary care to address short-term pressures’, it said.

It added: ‘The lack of clarity surrounding contractual arrangements beyond 2024 and the move to commissioning at ICS level is leading to apprehension regarding future funding for primary care.’

Ruth Rankine, director of primary care at the NHS Confederation, said: ‘Primary care is the front door of the NHS and carries out 90% of contact with patients, so it is imperative that has full representation on ICS boards in order to ensure local communities are offered the best care and services.

‘While a number of PCN clinical directors and GP federation leaders are already engaged in work at system and place, this is not yet happening across the board and it is concerning that over half of primary care leaders who took part in our survey said that they lacked a clear understanding of the role of primary care networks in the new ICS structure.’

She added: ‘There is a real desire from primary care leaders to have a meaningful role, however, we need to recognise the context within which they are working and the challenges on their time, they must be given the support they need if the health and care sector is serious about system working, collaboration and focusing on local need.’

In February, the Government announced plans for ICSs to be given the statutory power to commission NHS services currently held by CCGs in England, as part of wider NHS reforms.

NHS England has told Pulse that it will continue to negotiate a national GP contract following the overhaul.

Previously, the BMA has said that NHS England proposals to abolish CCGs were of ‘significant concern’ for GPs and could cause ‘significant changes to their working lives’ if they go ahead.

LMCs and CCG leaders have also raised concerns about the plans.

This story first appeared on our sister title, Pulse.

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