GP leaders withdraw support for IHO model amid fears it will disadvantage practices

Exclusive GP leaders in one area have withdrawn support for the local integrated health organisation (IHO) model, as they said it was unlikely GP practices would be on ‘equal footing’ with trusts.

Doncaster LMC said it had ‘engaged extensively’ in discussions with the ICB and others around the development of an IHO model for Doncaster in the last year.

The LMC’s chief executive Dr Dean Eggitt told Pulse that national guidelines around IHO contracts have been ‘unclear’ and therefore it was difficult to develop and support a model ‘where we have equal partners’.

The LMC has now decided it ‘cannot continue in a formal support role’ for the current IHO development process, because the plans did not guarantee the conditions needed for ‘full and equal GP participation’ and risked becoming ‘a loose alliance rather than a truly integrated system’.

NHS England previously announced that trusts will have commissioning responsibilities for primary care under the Government’s new neighbourhood health model, as they will be eligible to hold IHO contracts as described in the 10-year health plan.

IHO contracts will hold the whole health budget ‘for a defined population’, with the model going live in 2027. Under the model, ICBs will contract a single IHO for an area, and the IHO will then contract a number of multi-neighbourhood providers, each of which will work with multiple single neighbourhood providers.

NHS England has recently launched a consultation on neighbourhood contracts, which said that where IHO contracts are established, the contract holder will ‘take on responsibility for resource allocation and service planning’ for the whole care pathway.

It also said that hospital trusts looking to take on IHO contract must demonstrate a good working relationship with primary care.

Dr Eggitt told Pulse: ‘Because guidelines about IHOs are not clear, it has meant that many of those parties around the table have struggled to understand what the Government wants from an IHO and one of the parties that struggled the most is general practice.

‘It has been difficult to help all parties understand what an IHO model could look like. Because of that, we have failed to reach any system maturity where we can develop an IHO model where we have equal partners.’

He said that the current model could provide ‘an opportunity for a strong provider’ such as a hospital trust to establish an IHO, and that if that happens, the system is ‘unlikely to be able to do anything but whatever they say’. 

Dr Eggitt added: ‘If that model comes to maturity, general practice will essentially have to fall in line. That’s not really the creation of an equal footing IHO, it’s not joint working.

‘What we were designing was a genuine joint working model. We have withdrawn from designing that genuine joint working model because provider organisations, including general practice, are not ready for it yet.’ 

In an update to GPs, the LMC said: ‘At this stage, we do not have sufficient confidence that the conditions required for a genuinely effective and sustainable model are in place.

‘While there has been progress in some areas, key elements of the vision for an inclusive and balanced partnership have not yet been realised.

‘In particular, the emerging approach appears unlikely to deliver the breadth of cross‑sector collaboration needed to ensure that general practice, local authority services, DBTH (Doncaster and Bassetlaw Teaching Hospitals Trust), RDaSH (Rotherham, Doncaster and South Humber Trust), and the VCSE can operate together on equal footing.

‘Without strong, mature relationships across all partners, there is a significant risk that the IHO will evolve into a loose alliance rather than a truly integrated system.’

The LMC said that in light of this, it is ‘adjusting its focus’.

‘Our role is to ensure that Doncaster general practice is ready, organised, and well‑positioned to engage constructively with an effective and deliverable model,’ it added.

Pulse has contacted South Yorkshire ICB for comment.

Before it was revealed that advanced foundation trusts would take on the first IHO contracts, then-health secretary Wes Streeting had suggested that there was ‘no reason’ GPs could not lead IHOs.

It comes as some ICBs have already chosen trusts – rather than GP practices – to lead their neighbourhood models.