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​Health Bill must give primary care a seat at the table on commissioning

The British Dental Association has joined with partners across primary care to ensure dentists, pharmacists, opticians and audiologists to have a proper voice on Integrated Care Boards (ICBs) set to be handed responsibility for commissioning decisions.

The Health and Care Bill currently before Parliament would shift the responsibility for managing the contracts for primary NHS services, including general practice, general dental practice, community pharmacy and primary optometry services from NHS England to ICBs. Partners warn current draft legislation risks leaving around 190,000 non-medical primary care professionals working in the NHS in England shut out of representation on the boards.

Together with the Pharmaceutical Services Negotiating Committee, the Association of Optometrists, the Association of British Dispensing Opticians, FODO The Association for Eye Care Providers, and the National Community Hearing Association, the British Dental Association is pressing for change as the Bill heads for Second Reading in Parliament.

As it stands the Bill only dictates that each ICB includes a member nominated by General Practice, with no insight from any of the other primary care professions. This is despite GPs accounting for only about a third of the primary care workforce in England.

To remedy this, during the passage of the Bill through Parliament partners are seeking the list of ‘Ordinary members’ of ICBs in Schedule 2 (p. 127) amended to include an extra member nominated by clinicians providing non-medical NHS primary care services within the ICB’s area.

BDA Chair Eddie Crouch said:

“Voices that make up three-quarters of NHS primary care risk being lost in commissioning decisions that affect their services and the millions of patients they treat and serve every day.

“General practice simply cannot be expected to effectively represent the views, perspectives and distinct challenges facing colleagues in the wider NHS.

“We believe that for the benefit of patients and the NHS the crucial contribution non-medical primary care professionals make to the local health and care systems must be recognised and reflected at every level of the NHS, including within Integrated Care Boards.

“The only way this can happen effectively is if colleagues are guaranteed a seat at the table. That means a board presence drawn from non-medical primary care professions such as dentists, community pharmacists or optical professionals.”

PSNC Chief Executive Simon Dukes said:

"All primary care providers must have a voice in the new Integrated Care Systems, including community pharmacies and their teams. Every day around 1.6 million people visit a pharmacy in England to access vital medicines, healthcare advice and other important services, such as NHS flu vaccinations. During the pandemic, public reliance on pharmacies has increased, reflecting the importance of pharmacy services to patients and local communities. It is therefore important that these new local systems recognise the critical role played by pharmacies and the whole of primary care, as well as general practice."

The representative bodies for primary eye care and audiology – ABDO, the AOP, FODO and the NCHA – said:

“Optical practices and other primary care providers are vital to population health and care, and need a voice at all levels of the NHS in England. That’s why we are working together and calling on MPs to include provisions in the Bill to make sure this happens starting with the new Integrated Care Boards.”