The warning comes after NHS chief executive Sir Simon Stevens told MPs on 9 March that reform plans set out in a recent government white paper should increase flexibility for commissioners – with statutory control over GP services shifting to regions to help break what are currently ‘completely separate funding silos’ for different NHS services.
The white paper outlined proposals to bring the NHS and local government together legally in integrated care systems (ICSs) – scrapping CCGs.
Responding to Sir Simon’s comments, BMA GP committee chair Dr Richard Vautrey said NHS England and the government must not renege on funding agreements made in the NHS long-term plan. The Leeds GP called for ‘transparency over spending decisions’ and ‘fair representation’ for NHS providers impacted by decisions made under the reformed model.
In a House of Commons health select committee evidence session on the white paper, Sir Simon said: ‘The first thing we are looking to overcome is the funding silos that the current law creates in a local area. Local commissioning groups have responsibility for planning and funding most community health services and local hospital services. But GP services…and specialist services are not overseen locally – statutorily they are overseen nationally by NHS England.
‘In my judgment, it makes no sense to think about how GP practice nursing works independent of the way community nursing works, even though at the moment those are completely separate funding silos. So bringing together the whole ability to plan and fund for a population – that’s what, if passed, this act would formalise.’
He added that the reforms ‘would bring together a wider group of stakeholders to make those planning judgments, not just groups of GPs on CCG governing bodies, but also other providers, patient groups and local authorities’.
Dr Vautrey told GPonline: ‘Effective collaboration between primary, secondary and community care services in a local area is by far the most efficient way of delivering high quality, continuity of care for patients in the community.
‘It is crucial however that proposals for collective local funding decisions to be delivered through ICSs are carefully considered and ensure fair representation from all those impacted by such decisions. As such, GPs need to be empowered to have an equal voice around the table along with the other organisations involved such as hospital trusts.
He added: ‘This cannot be about cutting funding which would break the commitment that NHS England and Improvement and the government made in the long-term plan. Rather, this is about ensuring that funding available for a local area is spent in a fair and effective way with adequate engagement from all parties and transparency over spending decisions.’
The BMA has argued that the profession will ‘need greater time’ to consider the ‘sweeping reorganisation’ – and ‘must not be rushed’ while doctors are continuing to provide care during the pandemic.