Half (50%) of primary care managers and leaders said they were ‘unclear’ or ‘very unclear’ about the role of primary care networks (PCNs) within integrated care systems (ICSs), a survey has found.
Meanwhile, only one-in-ten (12%) of the 200 PCN managers, clinical directors and GP federation leaders surveyed by the NHS Confederation said they were always involved in discussions at system level.
The Confederation said this highlights ‘ongoing anxiety that primary care is not being sufficiently engaged with or involved in ICS decision making’.
The survey results were published (27 May) alongside a series of requirements for primary care involvement in the development of ICS structures, governance and culture.
‘Strong voice for primary care’
The Confederation’s members called for better representation at system level to help remove barriers to engagement and collaboration, which they said are caused by the ‘perceived complexity of the primary care system’.
Similarly, guidance will need to do more to prevent a ‘tokenistic offer of representation’, and must instead show it understands what primary care can offer.
The report added that one way to achieve this was by engaging with newly emerging groups of primary care providers that ‘encompass all primary care, not just general practice’.
Participants – who were surveyed in February and March this year in response to reforms which will see CCG functions taken over by ICSs – also shared concerns that infrastructure support that links primary care into the wider NHS may be lost as a result.
‘There is a clear need from primary care to have clarity on the functions, accountabilities and interrelationships of existing arrangements,’ the report said.
It also warned that ICS proposals place commissioning functions ‘far away from the communities they serve’, adding that this risks putting decision-making at system level rather than local level.
The report added that ICSs must be equipped to ensure sensitivity to population health needs ‘at all levels’ for commissioning and service provision.
The NHS Confederation also called for collaboration to be promoted and additional funding to be made available to enable members to dedicate enough time to ICS leadership alongside their primary care roles – after the survey found 205% of respondents lacked time to devote to effective system engagement.
Lack of clarity is ‘concerning’
Ruth Rankine, director of primary care at the NHS Confederation, said it is ‘imperative’ that primary care has ‘full representation’ on ICS boards, in order to ensure local communities are offered better 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,’ she said.
She added that there is ‘a real desire’ among primary care leaders for meaningful engagement.
‘However, we need to recognise the context within which they are working and the challenges on their time,’ Ms Rankine said.
‘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.’
Nicola Davies, co-founder of the Institute of General Practice Management (IGPM), said that time was also a consideration for practice managers in getting to grips with the role of PCNs within ICSs.
‘I think one of the problems that we have as practice managers is that the ‘day job’ – the business of running our business is really a full-time role and absorbing additional information can be time-consuming,’ she said.