As the shift to neighbourhood working accelerates there is an important question that is emerging: where does the legitimacy of those talking on behalf of general practice come from, both with the GP practices themselves, and with the leaders of the other organisations across the partnership?

Practices and PCNs ideally want a say in which individual or individuals should take on these roles.  But as many of these roles are (or at least were) funded by ICBs, it often ends up being a direct appointment by them.  This lack of an obvious link back to practices and PCNs can create problems when it comes to legitimacy, which then in turn can make it difficult for these leaders to be effective.

For partner organisations the legitimacy of these leaders comes from their ability to convert conversations and agreements that are made into tangible action, rather than a clearly defined route back to practices.  They are far less interested in the process by which leaders came into post than effective services being put in place when agreements are reached.  The most common complaint from acute and even community trusts is that they invest time with GP leaders and nothing tangible happens as a result.  Instead, what they more commonly experience is a list of issues and complaints about their own services.

I recently spoke to Dr Sian Stanley on the podcast about this very issue.  She is very clear that legitimacy comes from delivery, not from representation.  If she as a general practice leader is able to work within the new provider partnerships developing within the changing NHS landscape and turn those conversations into the practical delivery of new services and new ways of working then her legitimacy will come from that.

This works with the practices, because they are happy with the tangible changes in service delivery, the opportunities to work within these services should they want them, and the financial returns these generate for the practice.

And it works for the partner organisations, who can see the result of their own investment of time and energy into partnership working in actual service delivery.

The impact in West Essex has been tangible, with general practice playing a leading role in the running of the urgent treatment centre and developing further services to change the model of care, all of which are generating a return for the local practices.

But this is in stark contrast to many parts of the country where place-based partnerships and system working feels more like a lot of meetings and a drain on leadership time than an enabler of actual change.

The really important take away for general practice, then, is to consider whether they have the right people representing them in system discussions.  The right people are those GP leaders who can make change happen, who can set up new services from scratch and who have a track record of delivery.  Often they are the people who set up shared assessment and treatment sites during covid, or got the immunisation sites up and running, or who have set up system wide delivery models through federations or other such organisations.

The point is they will have a track record of delivery and of setting up services at-scale.  People who will be able to deliver within the emerging integrated care system will already have experience of doing it.  These are the people general practice needs to be in leadership positions within the new system, because these are the ones who have the best chance of making the left shift a reality.

Equally, what won’t work for general practice is having leaders in place who understand the role as attending meetings, and of giving a general practice point of view, rather than of making change happen.  Sooner or later the system will get frustrated with these individuals and the most likely result will be general practice being bypassed when changes are made.

The neighbourhood system presents real opportunities for general practice to re-shape the system of care and to strengthen the role of general practice and community services within that.  But the first step to grasping this opportunity is ensuring that it has the right leaders in place.