Read again: Navigating NHS integration: Will independence survive?

Delve into the intricacies of NHS integration’s effects on general practice, offering practice managers valuable insights into potential structural changes that may significantly influence and redefine their roles within the evolving healthcare landscape

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

The NHS has a new fixation: integration. The burning question is, how do we seamlessly connect everything to better serve patient needs? But lurking behind this enthusiasm is a concern – could this obsession bring an end to the independent contractor model for general practice?

The integrated care system quandary

The move towards integrated care systems isn’t proving beneficial for general practice. The internal market, in play since its introduction in 1991 until the publication of the Long Term Plan in 2019, has technically lingered until last year’s new legislation. Yet, for all intents and purposes, we’ve been navigating the new system for the past four years.

During the internal market era, the system sought to make general practice the “purchaser.” Various attempts were made, from GP fundholding in the 1990s to Primary Care Groups, practice-based commissioning, and, eventually, Clinical Commissioning Groups.

The integration conundrum

The shift to Integrated Care Systems has disrupted this model. The pivotal question is no longer about making general practice effective purchasers. Instead, the focus has shifted to integrating general practice seamlessly with the broader healthcare system.

The NHS Long Term Plan, leading with confidence in its first chapter, boldly declares: “We will boost ‘out of hospital’ care, and finally dissolve the historic divide between primary and community health care.” The perceived problem with general practice is its perceived separateness, independence, and lack of connection with community and hospital services.

Enter Primary Care Networks (PCNs)

To tackle this, the NHS introduced Primary Care Networks (PCNs). The Long Term Plan introduced PCNs as GP practices covering 30-50,000 people, funded to work collaboratively and create integrated teams of GPs, community health, and social care staff. The intention is clear – PCNs as enablers of integration.

While PCNs were envisioned to address primary care pressures, the Fuller report introduces Integrated Neighbourhood Teams, a souped-up PCN model aiming to achieve integration more effectively.

Structural solutions looming

The big question: Will networks and neighbourhoods successfully integrate general practice with the rest of the NHS? If not, the default solution might be a structural one – nationalising general practice and making it part of the NHS. This has sparked recent discussions by politicians like Sajid Javid and Keir Starmer, and certain NHS leaders, who see structural integration solutions as clear and enforceable, even if they don’t foster the relationships crucial for effective integration.

As of the latest update, forced nationalisation of general practice seems unlikely. However, the burning issue for policymakers remains how to integrate general practice effectively. Unless PCNs and integrated neighbourhood teams show significant progress soon, a more forceful push to make general practice a full part of the NHS appears inevitable. The NHS integration journey continues, and the fate of independent practice hangs in the balance.

This shift towards healthcare integration presents a pressing challenge for practice managers, requiring strategic adaptation to navigate the changing landscape and ensure the continued effectiveness of independent practice within the evolving healthcare system.