What Does the Health & Care Act Mean for General Practice?

The organisation of the NHS is changing in July 2022 as a result of the government’s Health and Care Act which received Royal Assent back in April. The published aims of the Act are to help the NHS to recover from the Covid pandemic, to reduce the backlog, and to create a new, more joined-up model for health and social care for the future.

“The COVID-19 pandemic has shown what can be achieved when we work together across NHS teams, organisations and systems with our partners in the care sector and beyond, and these reforms will help us to deliver for patients and their families.”

- Amanda Pritchard, NHS Chief Executive

What Organisational Changes Does the Act Introduce?

The key change for the NHS is the replacement of Clinical Commissioning Groups (CCGs) with statutory Integrated Care Systems (ICSs). This formalises a shift towards collaboration between service providers across a geographical area. The NHS, alongside a range of partners, will work together “to develop a plan to address the broader health, public health, and social care needs of the population”.

The overarching aim of this organisational reform is to overcome historical divisions between local councils, health and social care, GPs, hospitals, physical and mental health, in order to better serve the people seeking to access medical care. When we asked GPs what they thought of the changes, they were broadly supportive:

“I think one of the most significant benefits would be more effective communication between the different organisations and health and care teams involved which would lead to improved patient care, population health and reduction in health inequalities. Also having one integrated system for documentation, patient record and keeping patients healthy in the community and avoid unnecessary hospital admissions. Understanding the needs of the community and adapting services to those care needs.”

- GP

How Will ICSs Impact the Work of GPs?

General practice has the potential to be one of the most sharply impacted sectors as these reforms come into play. CCGs recognised the key role played by GPs in their communities and ensured them a significant role in system-wide decision making, whereas the Integrated Care Board (ICB) requires only one GP to be appointed for the whole geographical area. GPs we spoke to had concerns about this limited representation:

“Loss of local GP voice and influence. Our local CCG had around 8 GPs on the governing body, the new ICB structure replacing it has only 2 GPs, other providers are being represented with equivalent or greater voting rights to GPs despite not having as much involvement in patient care.”

- GP

“I believe it risks destabilising primary care which is already suffering with the lack of GP workforce and recruitment crisis”

- GP

What Can GPs Do To Ensure Their Voice is Heard?

GPs are keenly aware that their voice is now one amongst many; a genuine desire on everyone’s part, to work in a unified way for the best interests of patients is therefore, paramount. Two ‘schools of thought’ are emerging about the ways in which general practice can amplify its voice in these discussions:

  1. Relieve Pressure on Acute Care. Taking on some of the work that hospitals currently manage (outpatient and minor procedures) would increase the relevance of general practice within the wider system discussion.
  2. Generate New Ideas. GPs recognise themselves to be proactive partners in the process of change, offering strategies and ideas that make them integral to the development of unified delivery.

“ I feel there should be more involvement of practising GPs in the ICS infrastructure to help shape the delivery of care. It would be good to hear about the opportunities available to GPs to get involved as well.”

- GP

A Pivotal Moment For Healthcare

Across the UK, healthcare is still struggling to manage the enormous backlog left in the wake of the pandemic. The task of the new ICSs is twofold therefore: tackling waiting lists and addressing prevention. This pivotal moment has been described as shaping healthcare for the next generation. General practice will need to adapt as part of the change, but there can be no doubting its importance in NHS evolution.

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