Implications of the Health and Care Bill for general practice

The new Health and Care Bill sets out how the government plans to reform health services in England. Alison Oliver looks at what this will mean in primary care

The Health and Care Bill which you can view here, is the first major piece of legislation affecting health and care services in England since the Health and Social Care Act of 2012. It puts into legislation the shift of the NHS towards more integrated service delivery, with bigger block contracts covering whole populations.

In summary, health and social care delivery is organised around:

• Systems – covering a whole integrated care system (ICS) with a population of between 1 and 3 million, and with responsibility for strategy and system-wide planning
• Places – covering a population of between 250,000 and 500,000. Bringing together health, social care and voluntary sectors to redesign local services in cities and towns, likely to be co-terminus with local authority boundaries
• Neighbourhoods – covering Primary Care Network (PCN) areas (population size 30,000–50,000), with providers of primary care working with other providers as part of multidisciplinary teams.

Under the Bill, CCGs will be abolished and every area of England will be covered by an integrated care board and an integrated care partnership, which will together make up the ICS.

Integrated care boards will be responsible for commissioning primary care. The boards will include representatives from general practice. Integrated care boards will have flexibility beyond this minimum requirement to determine their own governance arrangements, including the ability to create committees to undertake delegated functions.

Integrated care partnerships have the role to develop strategies to address health, social care and public health needs in their area and to support partnership working.

Integrated care systems are currently voluntary partnerships, but the Bill will put them on a statutory footing, making them more transparent and accountable.

Key points for general practice

• General practice will have representation on each integrated care board, but how strong or ‘diluted’ that voice might be will be dependent on the overall composition of the board.
• It is unclear what role PCNs will play in the new ICSs beyond the end of the current network contract directed enhanced service. It is possible that these services will be brought within the scope of system or place level integrated care partnerships.
• Many GP provider organisations/federations already cover the place geography and may be well qualified to take on integrated care partnerships as well as to represent their member practices in the ICS. GP provider organisations may need to review their constitutions to ensure that they can fulfil this role.