This week will mark the end of the current system of Clinical Commissioning Groups and the commencement of the new system of Integrated Care Systems (ICSs).  It also represents the opening of a window of opportunity for general practice to take action that might not last for very long.

Many consider this current round of system changes to be just another turn in the wheel of NHS structures, the latest in a line of changes that have been happening every few years for at least the last 20 years.  But my sense is that this is a much more fundamental change, and one that could mark the beginning of an (even more) difficult period for general practice.

The end of CCGs marks the end of the purchaser provider split and the internal market that has been the organising principle of the NHS since 1990.  Alongside that principle has always been the idea of a primary care led NHS, and this also is coming to an end.  Instead, ICSs are based on the principle of providers working together, but of course not all providers are equal and the dominance of trusts and in particular acute trusts creates huge risks for general practice around priorities, contracts and funding.

How can general practice future-proof itself within the new system?  What action can it take?

The good news is that it seems that there is unlikely to be a nationally prescribed ‘solution’ for general practice.

When the system talks about needing a solution for general practice it means how can it work with general practice playing its role as a partner provider in developing system-wide responses to the challenges local health systems face.  With the GP leadership role of CCGs gone, there is no obvious route for working with general practice.  When there are upwards of 50 practices, 10 PCNs, and maybe 2 or 3 federations and LMCs in any area it can be virtually impossible to find any kind of consensus across general practice, let alone a shared commitment to collective action.

Despite Sajid Javid floating the idea of GP nationalisation earlier in the year, and the incorporation of general practice into an existing NHS organisation as the best solution, the Fuller Report very much points towards the development of local solutions for general practice within each system context.

The challenge for general practice, then, is to demonstrate that is can organise itself in any given area, that it can be united, and that it can create a consistent and influential voice.  If it can do this effectively, it can future proof its own autonomy as there is no need for the system to go down the route of asking another organisation to take over control.

But there is no time to waste.  It wont be long before ICSs find their feet and start to try to impose solutions upon general practice.  While currently this might seem well outside their control, if funding for general practice shifts from national to ICS level then they will most likely have the levers to be able to make this kind of change happen.

There are plenty of areas up and down the country already working hard to try and create a local cohesion across GP practices and organisations.  It is really important that everywhere starts to consider how to develop this in their area.  If practices do not start this work now, it may end up being too late and someone else may be brought in to do it to them.