Only GPs with PCN director experience can sit on some integrated care boards

Exclusive Only GPs with PCN director experience will be eligible to apply to sit on integrated care boards (ICBs) in some areas of England.

A Pulse PCN analysis of newly-published ICB constitutions also revealed that the vast majority of areas will only have one member representing primary care services.

GP leaders warned that the constitutions were ‘overly restrictive’, risks ‘missing out on the best candidates’ and – critically – risk excluding LMCs.

Established via the Health and Care Act 2022, each of the 42 Integrated Care System (ICS) areas will have one board each, which will assume commissioning functions from CCGs from 1 July.

Government guidance stipulates that each board must consist of at least one representative from primary care services, although they are free to appoint more than one if they choose.

However, a Pulse PCN analysis of ICB constitutions has revealed that:

• Three ICBs will require their primary care board member to have experience as a clinical director, or in a similar leadership role.
• Surrey Heartlands ICB and Frimley ICB have stated that this member must also have experience working as a director for a PCN within the ICS area.
• The majority (25) intend to appoint just one primary care member, with 15 appointing two board members and two ICSs appointing three.

The constitution for Surrey Heartlands ICB outlines that candidates for its single primary care representative position ‘must be a director of a primary care network within the ICB’s area’, in addition to being a registered GP and member of the RCGP or GMC.

Meanwhile, Frimley’s constitution states that one of its two primary care board members must ‘have knowledge and recent relevant experience of acting as a primary care network clinical director’.

The constitution for North West London ICB states the nominee for its primary care member must currently hold an ICS clinical role such as a PCN lead or associate medical director for primary care.

Across ICBs, the plans indicate there will be significant variation in the leadership and experience expected of primary care representatives around the country.

Other stipulations within the constitutions include:

• In Cheshire and Merseyside, the representative must hold a licence to practice as a GP.

• Dorset ICB states the member ‘must be engaged to provide Primary Medical Services for at least two sessions a week’.

Dr Clare Bannon, BMA GP committee policy lead for commissioning and provider development, said: ‘Ever since the inception of ICSs, the BMA has been clear that GP representation and leadership is absolutely essential – something echoed in the recent Fuller Stocktake.

‘GPs have led many models of primary care provision and collaboration, well before the introduction of PCNs and, crucially, know their communities, regardless of their involvement in PCNs.

‘Making experience as a PCN CD a prerequisite for a seat on ICBs is overly restrictive and risks missing out on the best candidates, for example the many skilled GP leaders from other organisations such as CCGs and federations.

‘ICBs must ensure that they harness the depth and breadth of primary care expertise GPs from all walks of life can provide.’

She added that it is ‘critical’ that LMCs have a voice within ICBs and wider ICSs.

Dr John Hughes, chair of grassroots campaign group GP Survival, said the primary care board member exists to ‘fit the corporate image of the ICB’ rather than to represent GPs, suggesting that the criteria for appointing them ‘is to ensure that’ outcome.

He said: ‘Sometimes, the people who are leading PCNs are the same people who would have been involved in CCGs, and they often don’t have quite the same direction of travel as, say, an LMC person representing the interests of GPs.

‘They are very much there to represent the board or the organisation they’re in charge of. So that may not necessarily be the best thing for local GPs.’

He added that there should be LMC involvement, noting that many ICB areas will also encompass several committees.

Dr Hughes said: ‘In Greater Manchester we did have an association of Greater Manchester LMCs, so ideally [the primary care representative] would be somebody nominated by that.’

The ICBs and NHS England declined to comment.

GPs had previously warned that the ‘vital expertise’ of GPs could be lost with the demise of CCGs, with some last year claiming that more must be done to prevent ‘tokenistic’ GP representation on ICSs.