Management in Practice spoke with GP partner Dr Farzana Hussain, who is set to speak at Management In Practice London, the title’s first face-to-face event since the Covid-19 pandemic began.

Dr Hussain is a GP partner at the Project Surgery in East London, clinical director for Newham Central 1 PCN, and an LMC committee member.

How does restructuring care commissioning impact individual practices?

Dr Farzana Hussain: On an individual practice basis, I think the only thing that practices like mine are noticing is that the communication is just from a more distant place. We used to have local, borough-based CCGs, and now they have morphed into a much wider footprint of the ICS. So an example from where I am in northeast London, we previously had seven CCGs, but now we have [one] ICS covering those seven CCG areas.

In our practice, while our day-to-day perhaps isn’t directly impacted, things like communication from a much larger commissioning-type body are.

We have noticed a lot of equalising: we might have been doing something a little bit differently with our local services compared to other CGGs, and now all of that is a lot more linear.

How well are practices adjusting to that change?

FH: It’s been hard  given day-to-day practice work at the moment: Covid and post-lockdown demand.

Communication is always hard, but suddenly to have different people emailing you with different demands is just another change practices have to get used to. It’s not always easy when we’re already so busy.

What are the most immediate or significant changes to commissioning bodies that will impact practice managers?

FH: It’s hard enough at the moment that managers are dealing with QOF on the practice level after a year when most of it was paused. Our practice managers are dealing with an expanded flu campaign that is coming right away and with delays.

On top of this, we are looking at [changing] local services, where perhaps we were providing one thing, one way. A good example is our medicines optimization: we were doing things just a little bit differently [compared to nearby CCGs]. So it’s yet another change for our practice managers who were just getting used to our local enhanced service. Again, it is more reading, more changes, and more implementation at a time which is phenomenally busy for them already.

One of the intentions behind the introduction of ICSs is to improve the way the NHS is able to tackle health inequalities. What is an individual practice’s role in delivering that?

FH: My understanding was that our ICSs were developed and the plan behind that was to address health inequalities and really focus on population health, by working in a much more collaborative, partnership-based way where ICSs would have a (if you like) provider/commissioner split, which would have everybody on the board: importantly local authorities. This would be to help think about the wider determinants of health, not just perhaps caring for sick people as we might have been doing in the past.

Now, how does that translate to individual practices? GP practices have forever been looking after the holistic needs of the patients, we are not specialists. Our practice managers don’t just think about the diabetes or the ENT problems, we generally know the patients, and we know everything about them.

So, I think practices were already in an advanced position. And I think  practices are the building blocks of  PCNs, which are the building blocks of ICSs. They have a really important role in actually delivering the needs of the ICS. And I’d like to see them a bit more involved and having a more equal dialogue with the ICSs rather than a one-way dialogue.

Dr Hussain will be speaking more on CCG, STP and ICS’ and what the change in commissioning means for practices at Management in Practice London next week (14 September).  

For more information about the Management in Practice Events, please visit: https://www.managementinpractice-events.co.uk/