General practice needs to act now

The replacement of clinical commissioning groups with the integrated care system provides an opportunity for general practice to act

CREDIT: This is an edited version of an article that originally appeared on Ockham

Many consider the system changes to be yet another turn in the wheel of the NHS structure – but the most recent could mark the beginning of a difficult period for general practice.

The end of clinical commissioning groups (CCGs) is the end of the purchaser-provider split, the internal market that has been organised by the NHS since 1990. Alongside this principle has always been the idea of a primary care-led NHS – and this also is coming to an end. 

In contrast, integrated care systems (ICSs) are based on the principle of providers working together. However, not all providers are equal, and the dominance of acute trusts presents risks for general practice – for example, when it comes to priorities, contracts and funding.

What action can general practice take within the new system?

With the GP leadership role of CCGs gone, there is no clear route for working with general practice. In some areas there are 50 practices, 10 PCNs, and two or three federations and LMCs, which makes it impossible to find a consensus or shared commitment to make a change.

Sajid Javid floated the idea of GP nationalisation in early 2022, and the incorporation of general practice into the NHS organisation, but the Fuller Report points towards the development of more local solutions for general practice.

General practice needs to be able to organise itself, in a united way, with one consistent, influential, voice. This will future-proof its autonomy against another organisation taking over control – but there is no time to waste. Soon the ICSs may start to impose solutions upon general practice; if funding for general practice shifts from the national to ICS level, they will most likely have the leverage to make this happen.

There are plenty of areas in the UK already working to improve cohesion across practices. All surgeries must begin to consider how to develop before someone else is brought in to do it to them.