NHS Confederation - Clarity needed on the role of primary care in ICSs

27 May 2021 10:30 AM

Primary care leaders want to see more clarity about the role of primary care within integrated care systems and have warned that more must be done to prevent a ‘tokenistic offer’ of primary care representation on ICS boards.

A survey and report by the NHS Confederation PCN Network and Primary Care Federation Network of more than 200 primary care leaders, including PCN and GP Federation leaders, warns of a lack of transparency on the role of PCNs in the new integrated care systems, with more than half of respondents saying they were unclear about their function in ICSs.

Primary care leaders also voiced their concern that the current proposals to place commissioning at ICS level, as set out the Government’s white paper, Integration and Innovation: Working Together to Improve Health and Social Care, risks it becoming too far removed from local communities.

The report, The role of primary care in integrated care systems, highlights ongoing anxiety that primary care is not being sufficiently engaged with or involved in ICS decision making, with only 12 per cent of primary care leaders who responded saying they were always involved in discussions at system level.

Primary care leaders are also calling for additional funding to allow them to dedicate enough time to system leadership alongside their primary care roles, with 20 per cent of respondents citing a lack of time to devote to effective system engagement.

The report highlights a number of other issues raised by primary care leaders on their role in the new ICS structure. These include: 

• uncertainty on primary care funding beyond 2024
• the need to adapt existing schemes such as the Quality and Outcomes Framework (QOF) and the Investment and Impact Fund (IIF) to provide the right incentives to help reduce health inequalities and reflect the differing needs of individual communities
• the provision of support for primary care to enable links into the wider NHS, as much of the current support is provided by clinical commissioning groups (CCGs), and primary care leaders fear this will be lost with the move to ICSs.

Ruth Rankine, director of primary care at the NHS Confederation, said: “Primary care is the front door of the NHS and carries out 90 per cent of contact with patients, so it is imperative that it has full representation on ICS boards in order to ensure local communities are offered the best care and services.

“While a number of PCN clinical directors and GP federation leaders are already engaged in work at system and place, this is not yet happening across the board and it is concerning that over half of primary care leaders who took part in our survey said that they lacked a clear understanding of the role of primary care networks in the new ICS structure.

“There is a real desire from primary care leaders to have a meaningful role. However, we need to recognise the context within which they are working and the challenges on their time. They must be given the support they need if the health and care sector is serious about system working, collaboration and focusing on local need.”