The move into integrated care systems means the importance of GP practices in a local area working together to create a strong and united voice is greater than ever.  It is not easy, but in lots of areas PCNs, federations, LMCs and even CCG GPs are working out how they can set aside their differences in order to increase their influence in the new arrangements.  But why is the same thing not happening nationally?

There is a lot going on nationally around general practice right now.  The contract for 2022/23 has been issued without any agreement between the GPC and NHS England for the first time that many of us can remember.  I don’t think I have ever seen a clearer signal that a unified national GP voice is 1) needed and is 2) absent.

It is not only the contract.  The Secretary of State Sajid Javid clearly has some pretty radical ideas when it comes to general practice.  He happily wrote the foreword for a recent publication by think tank Policy Exchange that advocated for the end of the national GP contract and for practices to be nationalised.

We also have the Health and Social Care Committee chaired by Jeremy Hunt, and its Inquiry into the Future of General Practice.  There must be a danger that general practice is becoming a political football between the former and current Secretary of State, as they seek to score political points off each other.

Within this context the profession needs strong and united leadership.  I don’t mean union style demands for more (money, staff, support, GPs etc), as the landscape clearly requires a more refined political touch right now.  No sector, whether it is hospitals, community trusts or mental health providers, will succeed right now by framing what they need in isolation from the rest of the system.  Instead they need to demonstrate their contribution to the wider system, and how investment in them can play an important role in making the integration agenda a reality.

It is not hard to hear the acute trust voice advocating for themselves as large, functioning organisations to be the ones who should take general practice under their wing to create joined up pathways of care for patients inside and outside hospitals.  What general practice needs is not only leadership that will articulate the obvious fallacies in such a plan, but also be able to put forward compelling alternatives that build the role and influence of the service.

The problem comes in holding the support of frontline practices, many of whom want to hear their leaders demanding more, and at the same time operating within this political national environment.  Too often GP leaders will simply repeat the demand for more (see this response to the Policy Exchange report from the RCGP) in order to curry favour with practices, rather than because it has any chance of influencing anything.

National GP leaders need to start modelling behaviours for local GP leadership.  It would be great to see the GPC, RCGP and the GP leadership team at NHS England working together as a united group.  There are some very talented and capable individuals across these organisations, and they could work together to strengthen the national influence of general practice (which would be in sharp contrast to the void we have now).  Together they could find ways of both having an impact on how integrated care arrangements develop, and at the same time be able to take practices with them.

When the GPs at NHS England and the GPs in the BMA talk against each other, it is the service as a whole that suffers.  It doesn’t matter who is right and who is wrong.  In the present day context general practice needs to be united at every level, and we especially need that at a national level.  Surely now it is time to put organisational differences aside, and to start working together for the service as a whole.