When you are working day in and day out in general practice, it is easy to lose any sense of perspective as to how the profession is viewed by those elsewhere in the system.  What do others think of general practice, and whatever it is, does it matter?

The reality of the purchaser provider split has meant that the views of others has not really been an issue for a long time.  Whether the local hospital or council ‘rate’ general practice has been neither here nor there, as the contract is primarily negotiated nationally, and locally there has always been a strong GP presence within the local commissioners.  This of course was baked into the design of Clinical Commissioning Groups, and was a staple of its predecessors Primary Care Trusts and Primary Care Groups.

Now things are about to be different.  The premise of Integrated Care Systems (ICSs) is that they are a collaboration between providers, who will agree between them how to design services and deploy resources.  The requirement for ICSs as legal entities to have GPs within their design is limited to say the least – one GP on an NHS ICS Board (not as a representative of the profession), and PCN involvement in place based arrangements (more explicitly to represent primary care).

The national GP contract will remain.  However, increasingly we are seeing any additional resources deployed through PCNs rather than direct to practices.  This trend will continue until 2024, and most likely beyond that.   This means (amongst many other things) the deployment of local resources to general practice will be essential, via enhanced services and the like.  The extent to which this happens, however, will be down to the local ICS.

The local ICS will be comprised of the various system partners.  The acute trust, the community trust, the mental health trust and the local council will be extremely powerful voices within the new arrangements.  So it will matter, for the first time in many years, how general practice is viewed by these partners.

How do those across the system view general practice?  Do they view it as a trusted partner, as a service that is worthy of investment, as the front line in the delivery of health and care?  Will the primary motive of each ICS be to invest as much resource as possible into general practice to improve the functioning of the system as a whole?

Of course views will vary across the country, and there will be a range of perspectives that are held.  The views will locally be influenced by personalities and the strength of relationships that exist at senior levels with local systems.  In some places GPs have rubbed local political leaders up the wrong way over a number of years, whereas in others extremely strong relationships have developed.  The credibility of the senior GP leadership inevitably affects the credibility of the service as a whole.

The underlying concerns that system leaders in some areas hold about general practice, whether they are valid or not, is the extent to which investment in general practice leads to any real returns.  There are concerns as to whether general practice is pulling its weight when it comes to the pressures on the urgent care system, with many (particularly in acute trusts) viewing the stories about lack of availability of GP appointments as a direct cause of downstream system pressures.  Council leaders on the other hand often bemoan the lack of impact the recent investment into general practice has had on health inequalities, and can sometimes hold the perception that practices are more motivated by money than by making a difference to the populations that they serve.

All of this can lead to an overriding sense from some system partners that general practice collectively is dysfunctional and fragmented, and that the consequences of this are felt by other parts of the system.

Don’t shoot the messenger!  In your area everyone may hold general practice in particularly high esteem.  There is no question that many have been impressed by the role general practice has played in the roll out of the vaccination programme.  But it may still be worth checking.  How others view general practice is more important now than it has been for at least 20 years, and where there are negative and unfounded perceptions in place it is critical that general practice takes action to start to correct these.  If it does not, life in the new system could start to prove very difficult indeed.