In many areas the Integrated Care System has set up a Primary Care Leadership group.  These groups are purportedly to discuss and decide all things primary care, and include membership from PCNs and federations, along in many places with leaders from pharmacy, optometry and dentistry.  The problem with these groups is that they simply do not work.

Often these groups are chaired by senior GPs from with the ICS, and on paper have many of the people that you think would need to be there in order for it to act as a leadership group.  But that is not how they function, and in no way can they be described as providing leadership to primary care.

This will not be a surprising analysis for those who have attended such groups.  If the roots and tentacles of these meetings go up into the system, rather than down into front line primary care, it is not a surprise that those on the front line feel zero investment in any decisions that these groups make.

Where does the ownership of these meetings sit?  If it is sitting within the system it is not sitting within frontline primary care.  These groups end up as simply a meeting that certain PCN CDs and GP leaders attend once a month, with no actual leadership functionality.

The underpinning issue for general practice is that both its leaders and the system are struggling with its transition from commissioner to provider.

As a commissioner general practice had a clear leadership voice at the system table, where its role was to speak on behalf of the practice populations it serves.  It has done this in various guises for over 30 years, ever since the purchaser provider split was introduced, along with the notion of a primary care led NHS.

But the new model of care is different.  In an Integrated Care System each provider is responsible for working together to improve outcomes for the local populations.  Outcomes are no longer the sole preserve of primary care.  All providers need to work out how they can contribute in partnership with others to improving these outcomes.

For general practice this means it is now a partner as a provider, not as a commissioner.  As a provider its leaders cannot operate under the statutory authority that commissioning groups (in any of their guises) provided for them.  Instead its leaders have to connect directly with front line practices, work with them, engage with them, and act on their behalf in order to be able to carry out their role as a leader of general practice who can work in partnership with other providers.

System primary care leadership groups miss out this critical step, because they are still operating in the old paradigm of GP leaders having some sort of system-imbued power over their practices, when the reality is they do not.  Any primary care leadership group that is built top down rather than bottom up will not be effective in the new system, because it is built on sand.

Instead, a general practice leadership group requires the authority, support and mandate of its member practices.  It needs to be a group that connects directly with its front line teams.  It must have a focus on what general practice needs to survive and thrive in the new system, how its role in the system can practically be developed, and how its resilience an be strengthened.  It needs to be recognised by practices and have its roots and tentacles firmly within the practices. Only then can it operate as a leadership group that will add value to the system.