ICB appoints hospital trusts – not GPs – to lead neighbourhood teams
A large ICB has chosen a number of hospital trusts to oversee the new ‘neighbourhood health service’ across its footprint.
South East London ICB said that, following the 10-year plan, it has approved partnerships between primary and secondary care, called ‘neighbourhood health service integrators’, in four of its six boroughs (see box).
The ICB’s plan suggests that secondary care trusts will ‘host the arrangements’ but it is unclear if this means they will hold contracts for neighbourhood services. Pulse has asked the ICB to clarify this.
Papers presented to the ICB show that the trusts have been chosen as ‘lead NHS organisations within the partnership’ given their ‘size, scale, maturity and local footprint’ and will hold the funding.
They also showed that the ICB is planning to spend £250,000 per integrator to ‘support early development and implementation’.
In Lambeth and Southwark, Guy’s & St Thomas’ NHS Foundation Trust (GSTT) will hold this funding on behalf of the integrator, according to the papers.
‘Due to the immediate ask for the integrator to hold the £250,000 integrator development funding provided by SEL ICB, this will be held by GSTT on behalf the integrator in service of the wider Lambeth Together Care Partnership organisation , with principles for spend being ratified by the partners with oversight of our Lambeth Together priorities,’ the document said.
The ICB said that these ‘integrators’ are not replacements for place-based care partnerships, but they are organisations within each borough that will provide ‘core infrastructure’ to support ‘effective integrated neighbourhood team working’.
The South East London ‘integrators’
- Bexley: The borough’s health and care partnership between the London Borough of Bexley, Bexley Health Neighbourhood CiC, Primary Care Networks, and Oxleas NHS Foundation Trust. Oxleas will host the arrangement.
- Lambeth: A partnership between Guy’s & St Thomas’ NHS Foundation Trust (GSTT) and Lambeth General Practice Provider Alliance. GSTT will host the arrangement.
- Lewisham: A partnership between the London Borough of Lewisham, Lewisham and Greenwich NHS Trust, primary care, South London and Maudsley NHS Foundation Trust and the voluntary and community sector. Lewisham and Greenwich NHS Trust will host the arrangement.
- Southwark: A partnership between GSTT and GP federations: Improving Health Ltd and Quay Health Solutions. GSTT will host the arrangement.
Source: South East London ICB
Health secretary Wes Streeting has previously argued that as part of a radical reform of the NHS, acute trusts should be able to provide primary care services and that ‘successful GPs’ should be ‘able to run local hospitals’.
However, following the publication of the plan, NHS England’s primary care director had said that hospital trusts will be invited to take on new contracts for neighbourhood services where GPs ‘are not stepping up’.
And the RCGP recently opposed plans for acute and community trusts to run general practice.
The 10-year plan announced the introduction of two new contracts as an ‘alternative’ to GMS, aimed at enabling GPs to work across larger geographies, delivering enhanced services for people with similar needs or focusing on services that require coordination across multiple neighbourhoods.
But following the announcement, GP leaders and experts have raised concerns that these contracts, which ICBs will be able to award to other providers including NHS trusts, could mean the end of the partnership model.
Pulse asked DHSC to clarify how the Government expects the two new contracts for neighbourhood services to work with GMS, and whether they are going to be layered on top of GMS, but DHSC failed to answer these questions.
It reiterated that PCNs will be ‘well placed to take on’ some of these contracts and that holders of multi-neighbourhood contracts will be big enough to host ‘at scale infrastructure’.
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READERS' COMMENTS [2]
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Game changing transformative revolution. Perhaps should be named the status quo partnership as sounds catchy 🤔
So we now have a confusing array of PCN localities, placed based care & tiered neighbourhoods. What a confusing mess. It was also always likely ICBs (which are predominantly secondary care led via boards with only token GP representation) were likely to be offers these contracts without scrutiny or tender. Trusts lack neighborhood knowledge are not nimble unlike gp practices and PCNs. PCNs/ general practice have also show what can be achieved over the last 5 years but are now not given the chance to direct these services. So what will be the outcome? With a confusing multi tiered approach, a lot of money will be wasted and lost. Most will be diverted covertly to secondary care which will ultimately fail as they have no experience in managing community based services. General practice will be relegated to a subservient role for secondary care plugging holes and deficiencies in services without renumeration. It’s the death knell for GP partnerships and a move towards a cheaper salaried service where GPs are employed by trusts in essence working as house officers for the local trusts having to accept an unlimited workload dump after a n inevitable series of “pathway changes” with no ability to push back. Sad end with total fragmentation of clinical care and I feel for patients who will be stuck in this poorly constructed loop.