This article has been provided and sponsored by Quality Compliance Systems.
Author: Tracy Green, Head of Primary Care, Quality Compliance Systems (QCS)
In years to come we may look back on Thursday 11 February 2021 as a red letter day for health and social care. For this was the date that the DHSC chose to publish a pioneering white paper outlining plans to create a network of Integrated Care Systems in England. Quality Compliance Systems, a leading provider of content, guidance and standards for both the health and social care sectors, has been following developments closely.
Integrated care is not a new concept of course. The seeds for closer integration were planted as far back as October 2014, when the NHS published its Five Year Forward View. Four years later it published its Long Term Plan, which saw it create 1,250 Primary Care Networks in July 2019.
There are also 41 Integrated Care Systems (ICS) already operating in England. While many of them work very well, there is no formal legislative framework which binds the health care sector to the social care sector. The white paper changes all of that and that is why, in my opinion, it is a landmark moment for integrated working. Not only does it set out a clear set of legislative proposals for Integrated Healthcare to provide joined-up care for everyone in England, the legislative structure forms the foundations of a Health and Care Bill, which is as radical as it is remarkable.
Integrated Care Systems: how they will work
If you haven’t had time to read up on the proposals laid out in the DHSC’s white paper, let me summarise. Essentially, each Integrated Care System will be divided into two separate parts. The ICS NHS Body will handle daily operations and will be responsible for CCG budgets, while the ICS Health and Care Partnership will take on the task of planning and commissioning a holistic programme of health and social care for the patient community.
But where exactly in this model of integrated care do general practitioners fit in? And how much influence and autonomy will they be able to command? The answers to these questions are not yet clear, but it hasn’t stopped GPs from debating the future.
Integrated Care Systems: Will GPs lose autonomy?
Dr Kailash Chand OBE, a retired GP in Tameside, for instance, is fearful for the future. In early March, he told Pulse that the white paper ‘was an obituary for general practice’. He worries about how far ‘a single pot’ budget will stretch, and is concerned that GPs ‘won’t be in control of the commissioning process’. His greatest fear, however, is that the overhaul will put the guiding principles of the NHS at risk by ‘de-professionalising and down-skilling the practice of medicine…’ [i]
While Dr Chand is right to suggest that GPs need to be at the heart of commissioning, until the Health and Care Bill is discussed in Parliament later in the year and then implemented in 2022, it is very difficult to comment on the majority of his concerns. But that said, Professor Martin Marshall, chair of the RCGP, remains hopeful that GPs will be at the heart of the process. He was recently quoted saying that ‘there is a suggestion that there should be a strong general practice voice at the top of integrated care organisations’.[ii]
Integrated Care Systems: a once in a lifetime opportunity
I’m optimistic that GPs will play a fundamental and pivotal role in ICSs. But at the same time, I don’t think that they need to be in control of commissioning to carry influence. They already have it. After all, GPs, who collectively see one million patients in a 24-hour period, form the backbone of preventative healthcare services. I think what is most important, is that all the stakeholders in the ICS have the same vision and the same sense of purpose. I also think that relieving GPs of sole responsibility for budgeting could be a benefit, as it will mean less bureaucracy and will free up more time for them to see patients.
GPs, who work in a PCN framework, already know this of course. Many have embraced PCNs and have flourished in the collaborative environment. ICSs will simply enable them to think bigger, better and bolder in tandem with secondary care and social care providers.
Integrated Care Systems: potential benefits
There’s a chance too to fix age-old problems that Covid-19 has ruthlessly exposed, such as reforming hospital discharge procedures, and working on ways to prevent unnecessary hospital admissions.
In the long term, unprecedented opportunities to compare, contrast and pool data in line with GDPR regulations are also likely to emerge. This rich seam of data has the potential to be transformative as it will reveal an accurate and real-time picture of the complex and often nuanced health challenges that local communities face. Equipped with this data, primary, secondary and social care services can work as one to provide a tailored package of health and social care to everybody who lives within the boundaries of the ICS.
Integrated Care Systems; the power of collaboration
But that’s not all. The collaborative nature of ICSs could also pave the way for information sharing on a local, regional and national basis. If data reveals that there is a mental health crisis in one region, or an increase in cancer or dementia in another, ICSs could share best practice learning, policies and procedures that they have put in place to tackle the problem. Furthermore, if a culture of data sharing ensues, then this could be the first step to eradicating health inequalities, which the Covid-19 pandemic has so cruelly laid bare.
Finally, while I think that Integrated Care Systems should not be considered a silver bullet, they have a vital role to play in helping to bridge health inequalities. How? Well, take Devon, my home county, for example. It often struggles to attract GPs, a point not lost on former Health Secretary, Jeremy Hunt four years ago. To entice trainee GPs to Devon, Cornwall, and other parts of the country that traditionally struggle to recruit GPs, he announced a £20,000 bonus package.[iii] Whether the policy was successful or not is impossible to say, but in my experience, GPs – particularly trainees – are not motivated by money. Instead they’re driven by making a palpable difference to the lives of the people they treat. Integrated Care Systems may offer them an opportunity to do that. That is why Thursday 11 February is a day to remember.
Quality Compliance Systems
Quality Compliance Systems (QCS) supports over 100,000 customers in the health and social care sectors. Founded in 2009, QCS’s vision has always been clear from the start; ‘Helping to create a fairer and more compassionate world’. This vision comes to life through the digital delivery of all necessary compliance policies, procedures, guidance and inspections tools that GP practices require.
In partnership with industry leaders, QCS has been able to take another huge leap forward with a pioneering vision around content. By adding to its team of industry experts, whose views and opinions regularly appear in leading healthcare publications, QCS has expanded its area of expertise and is now seen as a leader in best practice – as well as compliance.
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Is a total loss of autonomy on the way for GPs? 4 March 2021
[ii] GP Online
GPs need ‘strong voice’ in NHS after white paper reforms wards RCGP. 11 February 2021
[iii] Cornish Stuff
£20,000 bonus to practice here! Salary supplement for trainee GPs who want to work in Cornwall. 12 October 2017