New ICB model poses ‘existential threat’ to independent GP practices, BMA warns

Plans to transfer some ICB functions to neighbourhood teams pose an ‘existential threat’ to GPs as independent contractors, the BMA has warned.

Under a draft blueprint unveiled earlier this year, ICBs could soon hand some of their existing functions over to the new neighbourhood teams.

But the BMA’s GP committee said the draft new model for ICBs was developed and presented to the NHS England board ‘without any wider engagement’, in an attempt to ‘seize the transformation narrative’ ahead of the 10-year plan.

It warned that the changes could involve ‘vertical integration’ of GP practices with acute or community trusts, or ‘horizontal integration’ with at scale providers, such as GP federations, posing threats to the independent GP contractor model.

It comes after health secretary Wes Streeting 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’.

The draft model, shared with local commissioners, outlined areas which could be transferred to other organisations in order to help ICBs achieve a 50% reduction in running costs.

This included ‘primary care operations and transformation’ – covering medicines management, estates and workforce support – which should be transferred to ‘neighbourhood health providers over time’.

The GPC has produced a response to these plans, highlighting the risks they create to general practice.

It said that individual practices will ‘potentially feel increasingly marginalised’, risking vertical integration with trusts, horizontal integration into single providers, and that the plans would be ‘eroding autonomy permanently’.

The current 42 ICBs will likely merge to 27, with a focus on neighbourhood health and local authority boundaries, and the GPC said that ICBs are likely to be more removed from the day-to-day activities of frontline NHS staff, particularly in general practice.

The GPC added: ‘Given the Government focus on neighbourhood health, “primary care operations and transformation” would move to “neighbourhood health providers”, which are currently undefined.

‘There is, therefore, an urgent need for practices, PCNs and LMCs to have more information on how this transfer of functions may impact them.

‘NHS England may see vertical integration as a preferred model, with acute or community trusts.

‘There is also a potential for horizontal integration with at scale providers, such as GP Federations. Both these scenarios pose an existential threat to GPs as independent contractors.’

The document warned that trusts ‘are not appropriate’ to absorb the commissioning or operational responsibilities for general practice, ‘lacking experience, knowledge and evidence’.

It added: ‘Vertical integration risks greater financial deficit, contract instability and a loss of continuity. Neighbourhood structures are unknown with unreasonable and unsafe timelines.

‘Delegating both commissioning and assurance to at-scale providers (e.g. trusts or federations) risks the independent contractor model and potentially diminishes GP influence whilst creating perverse conflicts of interest.

‘GP practices are at risk of either being vertically integrated into the system or horizontally integrated into a single large provider.’

The GPC also shared two potential models of neighbourhood commissioning that they
believe GPs could pursue:

• Primary Care Neighbourhood Trust model – with an administrative body reporting to the ICB, responsible for commissioning general medical, dental, ophthalmic and pharmacy services across a neighbourhood or locality of neighbourhoods. It could control a delegated budget for the delivery of core primary care contracts to upwards of 100,000 patients ‘as a subcontractor to the larger ICB’.
• Primary Care Provider Collaborative model – ‘legally constituted’, backed by the LMC and involving federations, which would include leaders and key providers in the primary care space to take on commissioning responsibilities.

The proposals for ICBs come in the context of the Government’s plan to abolish NHS England over the next two years in order to ‘reduce duplication’ with the Department of Health and Social Care. 

And the Government has also announced that a number for NHS quangos will be scrapped to cut ‘wasteful spending’ as part of the upcoming 10-year plan.