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Opinion: Split screen thinking required for primary care to thrive in the system


Opinion Spilt screen thinking required for primary care to thrive in the system
By Dr Nicole Atkinson
Medical adviser to the Primary Care Network at the NHS Confederation
19 October 2022

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Pressure on general practice has been growing for some time and has never been greater. So, while primary care leaders welcomed the recent new support package set out by the Secretary of State, Thérèse Coffey, in the government’s Our Plan for Patients’, it was in full acknowledgment that it will only really pay lip service to what is needed to get through winter and beyond.

The numbers do not lie. General practice held 35m more appointments last year and 85 per cent of patients seeking a primary care appointment are already seen within the government’s new two-week target. This is set against a backdrop of ever-rising demand from patients many of whom have more complex needs, while contending with a shortage of over 4,000 full-time equivalent GPs. General practice has continued to work tirelessly to improve access to appointments to levels above those seen before the pandemic, but we are at a crossroads as need for care continues to rise in both volume and complexity, and the Covid booster programme ramps up along with the challenges that winter will bring.

As well as finessing enhanced access delivery and working at full pelt to once again deliver a new Covid vaccine roll out, primary care networks across the country are focussing on how to get through the next few months, as we head into what is likely to be one of the worst winters in the NHS for decades.

Yet with the benefit of space and time, sadly a luxury that often feels very distant, what leaders in primary care networks want to turn their attention to is the strategy needed to develop their long-term relationship and roles in integrated care systems.

What both systems and primary care networks (PCNs) really need is to be afforded the opportunity of split screen thinking – to deliver on the urgent tasks while aligning and developing their future reality. To make this a success, investment in time, energy, and commitment will be required by both sides.

It is imperative systems continue to work and support primary care with winter pressures, while at the same time ensuring that longer-term network development continues.

Three years on from their birth PCNs have made huge strides moving almost overnight to new ways of working, rapidly deploying new technology and recruiting thousands of additional staff – at the same time as playing a vital role in delivering 127.4 million Covid jabs. And all this has been achieved against one of the most unstable operating environments we have ever witnessed.

Yet if primary care is the foundation and primary care networks are the building blocks of ICS’, the crucial question is what more needs to be done to ensure we aren’t building the future on shifting sands?

Dr Claire Fuller’s stocktake on primary care was endorsed by all 42 ICSs with ICS leaders recognising primary care as an integral part of local systems, but at the same time calling on the government to address major blockers including falling GP numbers and other workforce challenges as well as insufficient funding.

PCNs report huge variation in how their systems are taking forward the Fuller stocktake recommendations, ranging from a document still sitting on a shelf, through to whole scale system redesign putting primary care sustainability and transformation as the starting point of their future system. This variation and at times lack of clarity, is proving frustrating to many in primary care.

This is why it’s crucial that networks and systems don’t wait to be told how to progress implementation. Rather they need to urgently work together to regain momentum and use the stocktake as a catalyst to start to solve the urgent problems of today while redesigning the future. And to make this happen systems will need to commit to freeing up additional capacity and resourcing to focus on primary care transformation.

Success will mean acknowledging, understanding, empowering and resourcing the critical role of primary care as a major strategic player at all levels. In systems where this appears to be working well, there is evidence of strong primary care involvement at system and place. Some areas are developing system primary care collaboratives to provide a collective voice and representation into ICS structures and governance and these arrangements are echoed at place to provide a golden thread from practice through to system. This way of working is helping to drive system and place enabled primary care transformation ensuring that networks are front and centre of the change.

The capacity and capabilities needed to support networks and future primary care transformation should not be underestimated.  The role of GP Federations and place will be critical in plugging any gaps, but systems need to ask themselves what more can be done if they are serious about ensuring primary care transformation is front and centre of the new world order.

As we countdown to 2024, and with as yet no guarantee on the future of PCNs beyond that, we are reaching a critical juncture. To survive and thrive we need to be enabled to double run – to think and plan both for the day to day and immediate pressures but, in equal measure for the long term, only then can we truly designing and delivering on the future we all want to see.

Dr Nicole Atkinson is medical adviser, to the Primary Care Network, NHS Confederation

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