The question of who should fund GP representation in ICSs and neighbourhoods was raised with me recently, in the context of concerns that locally the funding for this currently provided by the ICS might be reduced or even stopped.  If ICSs won’t fund it should practices or PCNs fund this themselves?

The immediate reaction to a question like this is that there is insufficient capacity at practice level as it is, and so any other demands are unlikely to be able to be met, especially if they are not funded.  It is hard enough meeting the time demands PCNs place on practices, let alone anything beyond that.

But I am not sure it is quite so simple.  Taking a head in the sand approach to anything that happens outside of the walls of the practice could end up meaning that the practice is not able to survive as it is into the medium or longer term.  We know there is a push for more general practice funding to be held and controlled within local systems (rather than via the national contract), and part of neighbourhoods is about how the system and general practice work together.  Leaving decisions to others about how funding is to be used and how this integration should develop feels extremely risky indeed.

Part of the problem is that many of the ‘primary care leadership groups’ that have been set up up and down the country have been established by the ICS rather than by general practice itself.  The group has an ICS legitimacy, but not one that runs from practices up to the people sitting round the table ‘representing’ general practice.  The danger with this scenario is that it becomes a group where general practice is informed of decisions that the ICS has made (rather than actively participating in the decision making), and a place where the rest of the system can come and tell general practice all of things it wants general practice to do.

So actually any reduction or cessation of funding by the ICS for this work may represent something of an opportunity.  The choice is not a binary one of either continuing to attend system meetings or not.  If general practice is going to have to pay for this itself (most likely through development, PCN or federation resources) then it can design for itself how this is going to work.

This is unlikely to continue to involve mass attendance at ICS-controlled meetings.  Instead it is more likely to be meetings that bring general practice itself together (PCNs, LMC, federation etc) to identify priorities and coordinate (likely much smaller) representation elsewhere.

Funded or otherwise there is a need for general practice within each local area to find a way of working together as a collective and organising itself.  Since the demise of CCGs there are no longer any obvious system advocates for general practices outside of practices themselves, and a collective strategy of hoping the system sees sense is not going to be sufficient.

Ultimately it also works in the system’s interest to have a collective general practice voice so I would still expect the majority of places to be open to providing at least some level of funding for this.  But if they don’t then local GP leaders need to access whatever resources they can and get creative in building mechanisms to ensure the local GP voice is heard.