Primary care is changing. What will this look like, and what is standing in the way?

Primary care is not currently fit for purpose

Staff capacity and morale are at an all-time low, whilst patient frustrations are at an all-time high.  This, coupled with the move toward integrated care systems (ICSs), has created an opportunity to create meaningful change that improves access to services and quality of care for all.

In response, NHS England commissioned a report to assess how newly formed ICSs and primary care could work together to improve patient care. The result was the Fuller Stocktake report, born out of a comprehensive consultation process that unpicked what works well to provide recommendations to accelerate integration in primary care.

But what does this change look like? And what will stand in its way?

What will the change look like?

The Health and Social Care Committee on Workforce has confirmed that the NHS will implement recommendations from the report, including creating Integrated Neighbourhood Care Teams (INCTs).

INCTs aim to do things differently for whole populations. These ‘teams of teams’ are designed to better support people living with long-term conditions by providing a fully integrated response across health, social care, housing, employment, benefits, and voluntary sectors. At the same time, they will be expected to cater for ordinarily healthy people who want faster access to a broader range of professionals.

Partnership lies at the heart of realising this vision, with success dependent on coordinated action. Primary Care Networks are an essential first step, but there are still barriers holding back more ambitious change.

To move forward, systems, services and clinicians need to be realistic about where they are now and tackle challenges head-on.

What is standing in the way?

The devil will be in the detail to make the vision a reality. Practical changes, effective partnerships and patient-centred design are essential steps in the process.

Firstly, practical changes to data infrastructure, estates and workforce must be made at all system levels to deliver the vision.

Although local areas should lead the charge to integrate their teams and systems, they must not be left to do so in a vacuum. Conditions must be created at a national level that enables informed decision-making locally. This means ensuring that local areas have access to the correct data, effective IT systems, and buildings that are fit for purpose. National bodies should ensure that data monitoring aligns with INCTs priorities to enable areas to understand what works and make changes in response to local needs.

At a local level, areas need to ensure that the right people are in place and that their workload is manageable.

The Royal College of General Practitioners’ response to the Fuller report said that:

“Addressing workforce and workload pressures, improving staff morale, and investing in support for change will be particularly key to achieving the report’s aspirations.”

This will be a challenge given that one in seven GP posts are currently vacant, and a third of GPs plan to leave direct patient care within the next five years. The recent Health and Social Care Committee inquiry on the future of General Practice highlighted significant variation between GP practices and the importance of learning from the ‘green shoots’ of integration across the country.  Implementing changes equitably will take time and requires full-throated Government support. Innovative ideas to support the frontline in the meantime will be essential to retain momentum and openness to doing things differently.  

Secondly, INCT partnerships must determine shared goals from the outset to ensure no one is left behind. Success will depend on ICSs supporting primary care to understand their patients from a population health perspective. Systems will be required to work together to provide a holistic model of care that promotes well–being and prevents ill health. This includes tapping into the knowledge of voluntary and community sectors skilled at working at the interface of clinical and social care and having unique insights into patients’ needs on the ground.  

Finally, services must be designed around a positive patient experience to improve quality of care.  The report recommends the creation of a care pathway that simultaneously provides personalised care for those with long-term conditions and streamlines access to care for normally healthy people. This is no mean feat.  To reduce the risk of this becoming an exercise of moving the deckchairs, patients should be involved in service and pathway re-design, and experts should be enlisted to make this happen. Done well, this represents an opportunity to create more sustainable services grounded in patient satisfaction.

Making the vision a reality

‘But it’s clear, isn’t it, the current model of general practice isn’t working as well as it could. That’s why I commissioned Claire Fuller to do a stocktake,…Claire did a very impressive job, but it’s now our job – mine and yours – to take that forward.’ Amanda Pritchard speech to NHS ConfedExpo 2022 Conference 

The Fuller report offers a much–needed and realistic solution as long as we welcome the change. All that remains is creating the right culture and conditions to deliver it.