A common challenge that many areas are having is working out who should be on the local leadership group for general practice. A specific question is whether this should include the (often newly appointed) system clinical leads, especially where they are GPs. So, should they be included?
To answer this question we need to go back to our understanding of what an Integrated Care System (ICS) is. As I am sure you know, an ICS is the new NHS infrastructure that aims to bring together providers from all areas including (but not limited to) primary care, secondary care, community care, mental health, social care and the voluntary sector, so that they can collectively agree how care is organised and how resources are deployed.
This is different from the previous system of Clinical Commissioning Groups (CCGs). In this (old) system the CCG as a commissioning organisation, with a membership of all the local GP practices, was tasked with deciding how care should be organised and how resources deployed on behalf of the local population.
In the new system there is no commissioning organisation, and no special place for general practice. General practice is simply one of the number of providers that have to work together to agree on how care should be organised and resources deployed.
The problem that general practice now faces is that the single membership organisation that could speak on its behalf into these system discussions (the CCG) no longer exists. General practice is multiple individual organisations, along with a set of at scale organisations including PCNs, LMCs, and (in some places) federations, and so is left at something of a disadvantage when it comes to system discussions. While the other organisations in an area are generally single entities with a clear leadership structure, such as the local hospital, general practice (and therefore its voice) is much more dispersed.
As a result general practice in many areas is creating a local general practice leadership group. The role of this group is to provide a united general practice voice into these system discussions.
At the same time the ICS is working to find ways of bringing the different provider organisations together and organise pathways of care across these organisations. To this end the system is appointing pathway leads (for areas such as planned care, urgent care, long term conditions etc etc) along with clinical leads for these areas.
These clinical lead roles could be taken on by any type of clinician from any type of provider organisation. But of course the clinicians with the most recent experience of this type of work are GPs, particularly those who worked in CCGs. So in many places we find that there are quite a number of GPs who have been appointed into these new system clinical lead roles.
While historically these same individuals may have been able to operate as system clinical leads on behalf of the commissioning organisation owned by GP practices (and so have a link into some form of leadership role for general practice), but now this is no longer the case. The system clinical leads have to operate on behalf of the system as a whole, and not on behalf of one single provider part of the system (such as general practice).
There is a clear difference, then, between the GPs on the local general practice leadership group, working to ensure the voice of general practice is heard in the system, and the system clinical leads (even if they are GPs) who are working on behalf of all providers within the system. When it comes to working in the best interests of general practice the system clinical leads are necessarily conflicted and should not be core members of the group.
There is of course a value to general practice of having GPs as system clinical leads. It can be valuable for these leads to attend the GP Leadership group meetings to ensure the group understand the work that is being carried out, how partnership work is progressing and the context in which they are operating.
But this is different from them being core members determining the actions general practice should take as it seeks to partner effectively with the rest of the system. This should be limited to those who operate on behalf of their practices, i.e. the PCN, LMC and federation leaders.
2 Comments
Very helpful overview & insight here, Ben. Thank you.
Dear Ben
I agree with your comments. We created in BOB ICS a GP Leadership Group (GPLG) for each place (one group for each of the three counties),. The membership is drawn from the different organs of General Practice in each place (LMC, Feds, Clinical Directors, and others we felt had experience to offer). They are a provider group. But the Terms of Reference for those groups highlights that the GPLGs were *not* representative bodies. Rather, the leaders were put forward due to their significant experience, and their function on the GPLGs are as provider subject matter experts. No GP employed by the ICB is on a GPLG.
Its still cluncky, but its working so far. The biggest benefit has been bringing all organs of GP together on one page, speaking from the same hymn sheet. It has made General Practice – ironically – potentially more powerful because we are not divded-and-conquered.
The biggest challenge for the ICS is that there is still no executive control over General Practice. The GPLGs cannot tell the different organs of General Practice what to do. Who will ‘sign off’ a project for General Practice? Consensus is still needed across all the organs of General Practice and the ICS has to win GP hearts and minds for a project to succeed. This is in stark contrast to NHS trusts where their ICS leads clearly can direct their organisaitons. Executive control over General Practice is the holy grail for NHSE locally as well as nationally – and something we prefer to resist.
The ICB funds the GPLGs from core and have lent their full support to the concept.
BW
Richard (CEO, BBOLMC)