The Role of an Integrated Care Partnership from a General Practice Perspective

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This short blog describes the role for General Practice in an Integrated Care Partnership* which is consistent with the values and strengths of traditional UK General Practice. This blog’s purpose is to stimulate debate in General Practice and with the leadership of the wider health and care system. This is a personal view but draws on some concepts that have been developed by One Care and tested and received approval from within General Practice in BNSSG.

It starts with the Primary System Principle:

Our system always seeks to work at optimum capacity**

This recognizes that we as a system have finite resources with which to deliver our ‘product’ of health and care services therefore individual providers commit to contribute what they do best and most cost effectively so that we, as a system, are best able to achieve the patients vision for great healthcare.

Our patient’s Vision:

“As a person I rely on all the parts our care system to function as if it is a single team with my best interests at its heart. I am confident that services will be there to support me to stay well and to help look after me when I am not. I know that no matter how complex or atypical my health problems are, my needs will not be ignored. I know too, that when my problems are common or minor, help for me will not be forgotten. The system that provides my care is open, transparent and always respects my autonomy. It demonstrates to me that it makes the best use of the tax I pay for healthcare in delivering the most effective, evidence-based care, with the money available.”

The Integrated Care Partnership Purpose:

The ICP Purpose falls out of this vision and principle. The ICP brings providers together to work on care pathways to agree who does what to deliver the optimum balance of quality (meeting the vision) and cost effectiveness (faithful to the PSP).

Funding flow:

The system agrees that budget, whether held by commissioner, ICP or provider is distributed in line with what is agreed by the ICP as it, by definition, delivers optimum value for money.

This needs to recognise that some providers operate within fairly immutable financial or statutory or external contractual restraints and all have capacity and workforce issues which may take time to change.

The Tools to make it happen

  1. A stocktake of General Practice: where are we now, where are the weaknesses in our current provision, what are we currently providing, what do we need to be resilient for today’s provision
  2. A review of the known expectations of General Practice over the next 5 years that may change, but which gives us a best guess destination for General Practice in 5 years.

This allows us to have a timeline between where we are now (1) and where we will be (2) and will help us know what we need and when we need it to meet those external obligations. (1&2 should be a core part of any wider Primary Care Strategy)

  1. A rate-card for General Practice that allows for the pricing of general practice non-core provision/contribution, to changes in pathways and care to help ensure resilient General Practice provision, in all non-core provision. All rate cards and modelling should be in the public domain. Other providers will also share rate-cards so that modelling tools can be readily produced to test pathways and to provide what-if scenarios, to identify optimum capacity provision for ICPs.
  2. Organisational, representative, governance and authorisation structure for General Practice at its different scales: Practice, PCN, Locality and System. Other providers should also share this information for their own organisation so that partners within an ICP can understand each other’s decision-making processes and commissioners can understand how to get considered, formal, sign off.
  3. Agreement to a set of system principles which enable and guide distributed decision making at every scale of provision within the system. (I suggest the principles from One Care’s ‘Health Care Without Walls’ are used as a starting point as in this blog, for context)

This framework can become an ICP ‘heads of terms’ that General Practices can safely, sign up to through their PCNs. Safely, because work only comes when it is agreed to and then only with the resources needed to make it happen in an integrated system where General Practice has agreed in advance what is expected of itself and partners. These terms may, over time, be incorporated into the contractual terms that define ways of working with partner organisations that are included within the PCN Agreement. If ICPs become the legal entities, that at some point they will need to be, this framework becomes an integral component of the legal document that creates them.

*Integrated care partnerships (ICPs) are alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete. These providers include hospitals, community services, mental health services and GPs. Social care and independent and third sector providers may also be involved.(Kings Fund)

**Our system, rather than individual organisations, agree to produce the most it can of the desired output (product or service) with the smallest amount of cost.

General Practice in ICP SWOT(BNSSG)

STRENGTHS

  • High quality General Practice
  • Committed network of providers
  • Effective GP federation providing supportive infrastructure
  • Clear representative and governance structure
  • Established Locality identities

WEAKNESSES

  • Lack of funding
  • Workforce capacity
  • Lack of front-line clinician engagement

OPPORTUNITIES

  • Reduce duplication
  • Reduce hand offs in patient care and clinician frustration
  • Improve patient experience (seamless care)
  • Improved patient outcomes
  • More effective use of resources
  • Fair funding for GP activity outside of core contract
  • Demonstrate the value of GP to both system and public

THREATS

  • Commissioner agenda: ‘command and control’ approach may undermine provider collaboration
  • System’s poor financial position (inability to support transition)
  • Lack of shared collaborative experience (trust)
  • No clear shared system vision or destination (don’t know where we are going or why)
  • Lack of cross-organisational, agreed, principles necessary for collaborative working (don’t know how we are going to work together)