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About timing

The new Health Bill will be a big transformation of NHS management – why do it now, in the middle of a pandemic, asks Dr Manu Agrawal

I’m sure a lot of my colleagues will have had the chance to read the new Health Bill, absorb the new three-letter acronyms and understand what it means for all of us. I mean, it’s not like we’ve had anything else to occupy our time – apart from delivering 3.5 million more appointments than before the pandemic. Oh, and delivering the biggest vaccination programme ever, and waiting for JCVI guidance just weeks before the booster programme starts. And there are other small matters of picking up secondary care work, handling abuse from patients, coping with staff shortages, Covid self-isolation, and attending countless meetings as PCN CDs.

Yes, I’m sure we’ve all had time to read and digest the new bill. 

And it seems to be the biggest transformation of NHS management since CCGs came into being.

Why now? Why test the service further in the middle of the biggest pandemic in a century? Do the powers-that-be think the caring part of the service is separate from the operational part? 

I can suggest two reasons.

First, because the pandemic has completely exposed how inadequately the NHS has been resourced and funded for the last decade.

Second, because they realise the system is so busy, that no one has the capacity to challenge this properly so it can be slipped through, especially as the BMA’s General Practitioners Committee is not negotiating with NHS England at present.

Perhaps it’s both.

Regardless, it is going to happen. So accepting that, my main worry is the lack of adequate GP representation on the new ICS boards. The bill calls for one GP. One GP who would sit on the board, making or influencing decisions on behalf of colleagues across a patch with a population, which in our case would be approximately 1.2 million patients. 

No one knows how the information will be cascaded to grassroots. Or does no one think it’s important any more? So that one GP will then discuss with CD representatives, who will then discuss with CDs, who will then discuss with practices, and then the feedback will go all the way back up the chain. What could go wrong?

General practice may be seriously neglected in the new system, unless there is proper representation at the ICS board level. And we need to move away from overburdening the already overstretched CDs to take that mantle, unless they are willing, properly supported and resourced.

Prior to the bill, in Staffordshire, we had agreed five places on the ICS NHS board with the system leaders. One from each of the two LMCs, and one from each of the three place-based partnerships CD representatives. I’m hoping by the time this is published, they will honour that under the clause of local flex.

We need a collective voice, a collective representation, a collective body, all singing from the same hymn sheet to make a difference.

There are worrying times ahead, and we need to be at the table, to do things  – rather than having them done to us.

Dr Manu Agrawal is clinical director for Cannock North PCN, Staffordshire, senior partner managing three practices in three PCNs and chair of South Staffordshire LMC

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