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Primary care is key to the success of Integrated Care Systems

Solving the wicked problem of health inequalities
By Sarah Walter
1 July 2022

Sarah Walter is the director of the NHS Confederation’s ICS Network

In May, the chief executives of all 42 Integrated Care Systems (ICSs) signed a letter to NHS England chief executive Amanda Pritchard endorsing the recommendations set out by Dr Claire Fuller, a GP and chief executive of the Surrey Heartlands ICS, in her recent Government commissioned review into the future of primary care.

That all 42 gave the review their backing sent a powerful message to central decision-makers in Government and the NHS, but also to the healthcare providers that make up their systems. That message is simple – addressing the multitude of challenges faced by primary care is fundamental to the success of ICSs.

Their letter, came just weeks after the Health and Care Bill received Royal Assent and became an Act of Parliament, triggering the arrangements that would make ICSs statutory organisations today 1 July, and fixing in law years of change in the healthcare system.

ICS leaders have faced a race against the clock to establish boards, partnerships and the committees and processes needed to turn theory into reality.  Yet despite this, they have not lost sight of their key purpose. They recognise that they have a unique opportunity to have a profound impact on health and care, improving outcomes for local populations, and to work with partners outside of the NHS to shift focus away from demand and towards need. 

Across all systems, primary care – including community pharmacy, dentistry, optometry and audiology – is at the forefront of these changes. Primary care and ICSs are not two different things; primary care is the first building block in an ICS.   With an emphasis on devolution and making decisions as close to communities as possible, it is clear that primary care is the integral to successful system working. 

Engagement in neighbourhoods – where Primary Care Networks (PCNs) are operating very close to their communities – is crucial to delivering community-centred services, to reaching populations that that rarely engage with the health service, and to building an understanding of those communities at a level of detail that arguably no other part of the health system can.

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Going out into communities and meeting people where they go – to churches and mosques, to supermarkets and taxi ranks – is one of the ways that these ambitions can be achieved, and we know that local primary care teams are already doing this in many places.

The golden thread running through Dr Fuller’s review is the need for PCNs to evolve into Integrated Neighbourhood Teams, something that is already underway in some parts of the country.

The ambition is for these teams to be equipped with the tools and resources to expedite changes in their neighbourhoods, working across organisational boundaries. For ICSs, putting in place measures to make this happen at pace, without leaving any neighbourhood behind, is a central focus.

However, it is crucial to recognise the significant pressure primary care is under significant pressure and that some of this work will be easier to implement for some than others. ICSs will also need to demonstrate how they can help alleviate these pressures to benefit the primary care workforce, balancing both the short term needs and the longer-term, strategic changes required.  

It would be trite to argue that one GP or PCN lead appointed to an ICP or ICB would constitute a representative voice for primary care in systems. However, what we have seen from our members is local arrangements being put in place that are driven by local needs. This means that ICSs are taking different approaches depending on what they require to succeed, not what they have been told to do by the centre.

Some ICSs have cross-system primary care committees or collaboratives and have then nominated representatives onto boards. Others have robust relationships setup for place-based partnerships to operate as sub-committees of the ICS, with primary care embedded into those partnerships. And others still have systems where colleagues nominate representatives directly onto boards.

With such breadth in the demographics, shapes, and sizes of ICSs, it is only right that we encourage local solutions. ‘Place’ and the opportunity that place-based arrangements will also secure primary care a significant voice in ICSs. The connection between neighbourhoods and systems, through places, is fundamental to the future ways of working in systems. 

System leaders are taking often bold, brave and ambitious decisions to ensure primary care is embedded at system level – but they also recognise that they can and should go further. This will be a journey that we take together in the months and years ahead. The NHS Confederation – through our ICS Network and our Primary Care Network – is committed to working with healthcare leaders across the country to support and drive the change we want to be.

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