A metric must be agreed with integrated care systems (ICSs) for shifting care close to home to help system leaders assess and report on progress, a report by NHS Confederation has said.
The report, called The Future of Primary Care, was based on engagement with ICB directors of primary care and looked at what the future system should look like and how to achieve it. It made several short and long-term recommendations to help ‘stabilise primary care’ (see box).
It suggested that to be successful in the government’s priority of shifting hospital care to the community, that the Department of Health and Social Care (DHSC) needed to agree a metric with ICSs that could measure progress.
‘This should not undermine local autonomy but be used as a tool to inform ICSs’ decision-making and responsibility for delivering on the government shift from hospital to community,’ it said.
The report also called for a review of the Carr-Hill formula to better address deprivation and rurality issues across primary care, and to support the development and commissioning of primary care at scale to provide services such as urgent treatment, diagnostics and day surgery.
It said: ‘By leveraging the capacity and skills within primary care, we can put primary care on the best footing to drive a relational model of care at the heart of a neighbourhood health service; a model which secures the future of the NHS and is led by those best positioned to drive it: the frontline.
‘A locally led and designed neighbourhood health service will facilitate a radical shift towards community and preventive care, enabling the NHS to transition from a reactive to a proactive care model. Maximising the impact of out-of-hospital providers and the voluntary, community and social enterprise (VSCE) sector, which significantly influence the broader determinants of health.’
It added that to achieve this, the NHS must work with primary care leaders and support the development of the workforce.
‘These leaders will shape local networks and benefit from improved infrastructure through primary care provider collaboratives, ensuring they have a voice at system level and that decision-making is equitable across all sectors of the NHS,’ it said.
It comes as Dr Penny Dash said this week that bringing together neighbourhood teams will take time. The preferred candidate to lead NHS England’s board emphasised the importance of neighbourhoods moving forward and in shifting money towards the community, but said that it could not be done ‘overnight’.
Key recommendations from the report include:
- DHSC should work with (ICSs) to agree on a metric for the care closer to home shift to help national and system leaders assess and report on progress.
- Commission a review of the Carr-Hill formula to better address deprivation and rurality issues, informed by the work in Leicester, Leicestershire, and Rutland (LLR) and Frimley.
- Support the development and commissioning of primary care at scale providers (primary care provider collaboratives) to provide additional services such as urgent treatment services, diagnostics and day surgery, with greater involvement in ICS elective reform plans.
- Reform general medical services regulations to allow limited liability partnerships (LLPs) to hold contracts and update NHS pension regulations to allow LLP partners to contribute to the NHS Pension Scheme. This step will enable general practitioners to limit their individual liability or risk associated with the business. This structure is commonly used in other partnership models, for example the legal profession.
- Prioritise reforms in the dental contract to overhaul the use of units of dental activity to incentivise improvements to patient outcomes over volume of activity.
- Ensure a new community pharmacy contract sufficiently renumerates activity and medicine costs, and recognises the skills and capabilities that exist, enabling pharmacists to work at the top of their licence. This will unlock innovation and much-needed system capacity.
- Create a shared-ownership model for primary and community data that removes the sole data controller responsibility from general practice. This should be grounded in improving data sharing and reducing the administrative burden and risk placed on individual GP practices.
- Review the effectiveness of the NHS 111 algorithms and develop a system with primary care at scale with greater capacity to manage risk and improve continuity and patient experience.
- Remove all role caps associated with the Additional Roles Reimbursement Scheme (ARRS), allowing primary care networks to recruit the skill mix appropriate for their population.
- Reform Section 75 of the NHS Act to enable greater integration and pooled budgets across providers. This would involve allowing a greater breadth of organisations that can pool budgets and greater range of services provided.
