On 26 May Prof Claire Fuller led a session hosted by the NHS Confederation to talk through the findings of her ‘Stocktake’ report on general practice, including contributions from the various workstream leads. The full report can be viewed here.
Prof Fuller and her team spoke with over 1,000 people attending workshops and engagement events, with the final report being endorsed by all 42 ICS chairs.
The main points covered are summarised below:
Headlines
- Access and continuity are the biggest challenges, both for patients and for GPs’ job satisfaction.
- There is a need to wrap a team around the practice, by transitioning from primary care networks (PCNs) to integrated neighourhood teams.
- There is also a need to wrap a team around the most vulnerable patients, for example those with frailty, complex mental health needs, children etc. These teams need to draw from community, secondary and social care and other services in addition to general practice.
- To improve urgent care all routes into local services need integrating to understand where the demand for urgent care is and use teams better to meet it. Again this extends beyond core general practice staff to include ARRS roles, pharmacy, dentistry, sexual health services and others.
- Preventative activity should work for people, not just for organisations, by delivering activity in ways and in places that suit different parts of local communities, although this should avoid stratifying people into categories. An example given was the success of pop-up Covid vaccination clinics and the possibility of using this model to increase the uptake of childhood immunisations.
- To deliver on the above there needs to be a cultural shift within general practice, community services and secondary care. Prof Fuller and other speakers did acknowledge the limitations of workforce, estates and resourcing in achieving this shift.
Integrated care systems
- ICS chairs should lead the creation of an environment where personalised care can take place, once more personalised care is being provide demand will reduce in turn.
- ICS need to understand the needs of the most vulnerable people, including how they want to access services which meet their needs. The voluntary sector has a big role in this and needs to be brought onboard.
- Commissioners should move away from a paternalistic approach to configuring services, and create an infrastructure where involving communities is central to everything.
- ICS should also avoid fixating on governance and relationships, and instead focus on delivering the care these structures are supposed to facilitate.
- Targets created in a top down way tend to shift activity, but not necessarily improve quality or outcomes, there also needs to be a consideration of what activity is not being done if resources are being moved to deliver on these targets. Targets should be owned and co-designed by the staff responsible for delivering them, along with patients.
- The report team have told the Department of Health and Social Care that more help with workforce, infrastructure and estates are necessary to deliver on the above.
Secondary care
- Trusts need to give time and attention to the wider determinants of health and wrap services around PCNs.
- Secondary care clinicians should go into the framework of PCNs and trusts should include joint leadership development, offer HR functions, estates and other support to primary care.
Fuller report remit and Londonwide LMCs’ submission
Professor Fuller is leading a wide-ranging national stocktake of how best primary care can be supported within the emergent Integrated Care Systems (ICS). The focus of the work will be on the practical next steps ICS can take as they assume a statutory footing from April 2022.
The key lines of enquiry are:
- What are the key priorities for ensuring a more integrated and effective NHS primary care service in future?
- What practical enablers are needed to realise this vision, and how should these best be put into practice?
- What type of leadership, engagement and decision-making structures are needed?
The essence of our response is that if the NHS is to be sustainable, it needs GPs and practice teams to be properly resourced to do what they do best: keeping people healthy in their communities, so fewer need hospital care.
We acknowledge that London primary care providers face special challenges. To improve the flow of patients through general practice, clear existing blockages, increase capacity and reinforce, maintain and sustain the existing system, developing systems, workforce, commissioners and educators need to work with LMCs, GPs and practice staff.
To maintain the high standard people have come to expect from UK healthcare within the Capital, London’s health and wellbeing must be built on a strong, coordinated, supported general practice. As an expert generalist medical service based in communities, general practice provides vital cost-effective health care and secures health improvement.
Our full submission can be read here.