In a letter to Pulse, the LMC chairs for Berkshire, Buckingham and Oxfordshire explain the relationship between on-the-ground GPs and the ICB regarding the plans for same-day hubs in the region
We are writing to you to pre-empt a likely error of interpretation in your recently published article in Pulse, ‘ICB rubber-stamps plans for same-day hubs and GP access ‘at scale’’ [23.05.24]. This article quotes the chief medical officer of BOB ICB, Dr Rachel DeCaux, as saying that the GP leaders and the LMC have ‘extensively shaped’ the Primary Care Strategy (PCS). This phraseology may have inadvertently given the erroneous impression that our LMCs in BOB endorse every aspect of it – we do not.
For context, three years ago BBOLMC facilitated the creation of GP Leadership Groups which are alliances of GP providers (practices, PCNs, and federations). These groups act as the ‘system partner’ for General Practice in the ICS. Though we work closely together, the groups’ mandate is different from the LMC, focused on high level strategy, project development and implementation advice – rather than representation. The “GP leaders” referred to in Dr DeCaux’s comments refer to leads of these alliances.
The inception of the PCS has pre-determined its outcome: The strategy was an ask of NHSE; NHSE instructed BOB ICB to commission KPMG (at substantial cost to primary care) to deliver this ask. There was no surprise amongst the GP profession that the KPMG’s provisional slides, as they emerged, were a template of the Fuller Stocktake and the NHSE long-term plan. Any (minimal) shared vision between the draft slides and grassroots GP vision were a convenient happenstance.
The profession was faced with a choice early on: to separate ourselves from what appeared to be a ‘done deal’ by NHSE, or to do our best to shape it to something more akin to grassroots vision and needs as best we could. The decision to do the latter was a pragmatic approach, a system expectation of the leadership groups, and a necessary exercise in system education and damage limitation.
As part of the consultation on the draft PCS, the LMCs submitted a 4,600 word feedback document which exposed the significant discrepancy between the draft PCS agenda and the priorities of grassroots GPs. We expressed significant concern for some contentious aspects, such as same day hubs. LMCs made concrete suggestions of what should be covered in the PCS.
Whilst there is still content in the PCS that is discrepant with representative grassroots GP opinion, it is of credit to the primary care team in the ICB that they made a concerted effort to incorporate much of the LMC feedback and work closely with the GP leadership groups in the development of the final version of the NHSE template strategy which injected in many important issues for our GPs in BOB.
But the process described above will not surprise your readers; the PCS roll-out in BOB, like many places across our nation, is a re-iteration of what General Practice is used to: an NHSE concept that GPs on the ground have to modify as best they can to minimise harm to the profession and our patients, and a top-down imposition of often-flawed concepts where the buy-in of General Practice is desirable, but not a necessity.
Yours sincerely
Dr Mark Green
Berkshire LMC Chair
Dr Stefan Kuetter
Buckinghamshire LMC Chair
Dr Gareth Evans
Oxfordshire LMC Chair
Thanks Mark. More of the same- they throw s*** at us and we do our best to play it as best we can. 🙄