One of the reasons for general practice to come together in a local area is to so that it can be an effective partner in the new Integrated Care System (ICS).  But what it doesn’t want to happen is that it simply becomes easier for additional work to be foisted onto the service.

Historically general practice has been seen as difficult to do business with, because it is made up of a large number of individual practices in any local area (along with PCNs, federation, LMC etc) and because the primary route of engaging with general practice is via the national contract rather than any local mechanism.

Integrated Care Systems have been tasked with finding their own ways of engaging general practice as a partner.  What the Fuller Report made clear was that rather than any national solution being imposed, local areas would develop their own.  While this in part has averted the threat of nationalisation that loomed large earlier this year, bringing general practice directly into the NHS within local areas (ie putting practices under the auspices of the local acute or community trust) may end up being the ‘local’ solution if general practice cannot demonstrate that it can operate as a system partner.

I have written previously that the first step towards this is general practice creating its own leadership group.  A key function of this board is that it operates as a single point of access for the system into general practice.

For a single point of access to be effective a number of things need to happen.  First is that all the local general practice organisations (PCNs, federations, LMC etc) need to commit to making it work.  The system can (and does) use the plurality of organisations within general practice to play it off against itself.  If one PCN says no to something the system can usually find another that will agree to what it wants.

What a single point of access requires is that all organisations across general practice commit to redirecting any approaches back to this access point.  This means all approaches will be treated in the same way and that general practice can start to provide consistency of responses.

Second is that the leadership group needs to identify one, or at most two, people to control the process.  These are the people that anyone wanting to access general practice are redirected to.  By having a very small number of people controlling the process it ensures a consistent approach to requests is taken.

The single point of access needs to be people, not a meeting.  When it is a meeting there is no filter in place.  Whoever wants to come to talk to general practice can come, without anyone controlling whether it is appropriate or not or whether it is a valuable use of the limited time GP leaders have together.

What the person in charge of the process for general practice does is act as a gatekeeper, and decide whether attending the leadership meeting is appropriate, or whether a paper could be sent round, or whether it just requires a simple message on the WhatsApp group, or what further work might be required before any item can come to the group.

Operating a single point of access in this way means that general practice can operate as an effective partner with the system by providing consistent, coherent and unified responses to system requests.  At the same time it means that general practice can keep control of its own agenda, not allow its time to be wasted, and maintain a focus on its own priorities.