There seems to be a general consensus that there needs to be a “GP presence” at the top table of the emerging new integrated partnerships, whatever they are called this week.
Everybody nods their heads to this but do they all mean the same thing? What are the other partner’s expectations of their GP colleague; are they looking for an expert or a representative. How should the GP prepare for their new role and behave in meetings? Well maybe they have a good start, particularly if the rhetoric of general practice being the bedrock of the NHS is believed.
The whole idea seems to be about providing a voice for GPs as providers, something that has been sadly lacking for a long time. But what is this voice and will it be heard?
Is it an expert voice that is required, someone who will advise other members of the Board what can be done in primary care, how it should be organised and importantly how it should be resourced? With such big expectations on primary care will they be able to deliver? We have all had experience of “experts.” They can sometimes deal too much in theory and in the ideal rather than what is deliverable by the average, overworked GP and their team.
Or is it a representative role, someone who has close links with grass roots general practice and can speak with authority on what is possible within primary care? Such a person would have a high level of trust within the GP community and would gain a mandate from GPs as to what he or she could commit them to. Obviously such a role would require a lot of energy to build up two way communication processes and would require some level of representative governance.
Who could fulfil this representative function? There has been an assumption in some areas that this would fall to GP federations. In others it is seen as an LMC role. So what are the relative merits and what might work in one area might not work in another. Federations are “GP provider organisations” but what they provide is sometimes quite limited. Federations are essentially a coming together of practices to deliver “primary care at scale.” Although some of our managerial colleagues would see all of primary care being delivered at scale the truth of the matter is that the vast majority of general practice will continue to be provided in individual practices. The LMC has, over the years been championed as the provider voice of general practice backed up by statute, intimately involved in discussions about workload, workforce and resources within practices.
Whatever is agreed locally, whether it is an expert role or a representative role, or perhaps a combination of roles, will need to command the confidence of the profession if it is to work.