I am going to write over the next few weeks a series of articles outlining the actions that general practice can take in a local area to be effective within the new integrated care system (ICS) environment.  This is the first of these articles, and is about putting a single board or leadership group in place for local general practice.

I have written previously on the potentially huge impact the loss of CCGs and the introduction of ICSs could have on general practice.  With general practice losing its system voice as a commissioner, it has to create one as a provider.  All signs from the Fuller report indicate that more of general practice funding will be channelled via ICSs (as opposed to the national contract) in future, so as a minimum local general practice needs to be organised to at least be able to negotiate effectively.

The first action that general practice needs to take is to put a single leadership board for local general practice in place.  As a minimum this needs to include the PCN Clinical Directors and the LMC Chair.  The system recognises PCNs, and the LMC has a statutory role to play.  If there is a local federation they also need to be included on it.

If general practice is not united it will be weak in the new system.  Different facets of the service will be played off against each other, as the system asks different people the same question until it gets the response it is seeking.  Equally, influence at system meetings is nullified when different parts of general practice argue against each other.  Strength comes from unity, and a single general practice board is the first step towards this.

There are a couple of important considerations to make about setting up such a board.  The first is one of scale.  Should this general practice board be at the level of the ICS, or of the local area (which more likely relates to the “place” area within the ICS)?  Whilst influence at an ICS level is important, the more natural grouping and ability for short term cohesion within general practice is at the local level.  One LMC, less than 10 PCNs and one federation feels both more manageable and more likely to be able to focus on common issues than one operating at an ICS scale.

Rather than having one large ICS group it would be much better for there to be several local place-based groups, and for the leaders of these to work together to influence at ICS level.

The second consideration is one of ownership.  There has been a tendency for local systems to try and set up these primary care leadership groups.  Groups set up in this way rarely work for a number of reasons.  First, the scale is often set at an ICS rather than local level, so there is little in common binding the members.  Second, the agenda is generally set by the system, and so becomes about an ability for the system to interact with general practice rather than general practice being able to influence the system.  Third, they quickly become just another meeting that busy PCN CDs and general practice leaders have to go to rather than being a place where important decisions are made, and so attendance and then influence of these meetings becomes poor.

Instead these groups need to be owned and created by general practice.  General practice needs to set the agenda.  There can be some space allocated for others to come to talk to general practice, but this is secondary to general practice working together to influence the system.  It needs to be where local general practice works out where and how it will influence the place-based board, where it sorts out general practice issues (like extended access) together, and where it shares information about local system issues.  If the system is running the meeting for general practice, this is not what the meeting will achieve.

This raises the interesting question of who will chair the meeting.  I know of a series of different places across the country who are already running these local leadership groups, and the role of the chair varies significantly.  In one it is a PCN CD, in another it is the LMC Chair, and in another it is the senior manager from the local federation.  What all these people have in common, however, is that they are trusted and respected by the rest of the GP leadership team.  It is not about getting the right role as chair, it is about getting the right person, and each local area will need to work out who that is for themselves.

Putting a local general practice leadership group in place is important but it is only the first step.  If general practice is going to survive and thrive in the new system it will then need to develop this group so that it is effective and has real influence in the system.  In the coming weeks I will outline the steps such a board needs to take to build its impact.