In a BMA survey
93 per cent of doctors in England want GPs and hospital doctors to work together more directly in a collaborative and co-ordinated manner. Worryingly, the same survey found that in England 73 per cent of doctors are not aware of the plans to establish integrated care providers.
Impact of ICPs on GPs
- GP practices will be required to sign up to the contract in order for it to operate
- ICP contracts will undermine the current partnership model
However, GP practices do not need to enter into this contractual agreement.
- ICP contracts will undermine the GMS contract and the partnership model of general practice, which the recent GP Partnership review found provides practices with the freedom to innovate; provides relative autonomy in decisions relating to patient care; creates a desire amongst GP partners to success as business owners and provides value for money.
- There is a risk that local commissioning strategies will erode the autonomy and choice of GP practices and other participating providers.
- Current procurement law means that combining multiple services into one contract risks the potential for non-NHS providers taking over the provision of care for entire health economies, as the contract would be subject to open competition rules.
- The BMA does not believe that new contractual models are required to achieve service integration and that the same outcomes can be achieved using existing frameworks. ICSs (Integrated Care Systems), for example, are already in operation and operate on the basis of allowing collaboration and integration with local agreements without the need for formal contracts.
- GPs must have protections in place whereby they reject the proposed models they have a commitment that:
(i) Their contracts, funding and services are ring fenced
(ii) They will have the flexibility to agree the contractual arrangement with the ICP to achieve greater integration, and;
(iii) There will be a mechanism for them to unlock further funding via (potentially) a separately commissioned contract to achieve this integration
- Whilst the direction for the ICP Contract contain requirements that salaried GPs must be offered terms no less favourable than the BMA model contract, as per GMS regulations, we expect all doctors employed under an ICP to be provided with nationally negotiated terms and conditions.
Further discussions on this with the BMA must be undertaken before any ICP contract is put into effect.
- GP practices working under ICP contract will have a ‘right to return’ should they agree to suspend their respective GMS/PMS contract and integrate fully into an ICP.
However, we retain serious doubts over the practicality of these proposals. Whilst it will be technically possible for a practice to return to a ‘suspended’ GMS or PMS contract there is no guarantee that the practice will return to an adequate level of funding.
There would be no guarantee for practices to return to their contracts for services beyond GMS/PMS, for example local enhanced services and previous CCG funding streams. It is likely that these will be contracted to as part of the ICP contract, and so the practice would need to come to a subcontracting arrangement with the ICP if it wished to provide services beyond GMS/PMS.
As patients stay with the ICP by default at any point beyond the initial two year break point, there is no guarantee that practice returning to GMS/PMS would be able to survive at all.
Practices that do manage to successfully leave an ICP will find themselves in direct competition for patients from a much larger organisation that would also control the area’s community nursing services.
Effectively this means that practices entering into a fully integrated model of working should consider it an irreversible process.
What you need to know if you choose to operate under an ICP contract
If a GP practice chooses to operate under such a contract there are two options or models:
Partial model: whereby member practices retain their core GMS/PMS contracts but sign a separate ‘Integration Agreement’ to operate under the ICP provider (guidance on the Integration Agreement can be found here).
Full model: whereby the practice core contract is ‘suspended’ and replaced in their entirety by the ICP contract.
Further detail and guidance on these models, including the BMA’s continuing serious concerns regarding the impact of the Contract, are available in previous BMA guidance notes.
ICP contracts: What patients need to know
It is not only GPs and their practices that will be potentially impacted by the move onto ICP contracts. Increased privatisation and the resulting fragmentation of services, a lack of consultation with the public and concerns over future GP funding all have the potential to impact the care patients receive.
The way in which general practice in the UK is structured is what gives it its strength and resilience. This independence allows GPs the freedom to innovate and provides relative autonomy in decisions relating to patient care, which makes them uniquely placed to advocate on behalf of their patients.
It is important that patients understand the risks associated with ICPs and what they mean for them. The BMA have produced a short explainer for you to share with your patients.