Ruth Rankine, director of primary care at the NHS Confederation, discusses the key priorities for the sector as the country moves into the next phase of the Covid-19 pandemic.
Primary care has been an integral part of the NHS’s response to the pandemic, undergoing enormous change and notably being the leading light of the hugely successful vaccination programme against coronavirus. As the front door for most patients carrying out 90% of initial interactions, there is no doubt that primary care will be the key enabler of the NHS’s recovery of services but to do so, it needs support, space and resource.
Having vaccinated over 42 million people in England and counting, the vaccination programme has shown the benefit of general practice and other primary care providers working together with a common goal. Transmission of the disease is going down and the immediate threat to frontline services is subsiding. Leaders are eager to embed this learning and reorientate to meet the changing needs of their patient communities.
But this could be an uphill struggle as the pandemic has left a colossal waiting list for elective care, with primary care supporting these patients to stay well in the community, as well as respond to the growth of Long Covid, manage long term conditions, and support the rising demand for mental healthcare. The latest data shows 28.4 million GP appointments were estimated to have happened in March, an increase of five million on February, with 45.5 per cent taking place on the same day as they were booked.
Primary care networks are a key component of the NHS’s ambition for more joined up care, focused on local needs and more services being provided away from hospitals and closer to their communities. The response to coronavirus has shown the benefits and potential of PCNs but we are moving onto a challenging next phase where their success beyond coronavirus can be truly realised to support patient care and wellbeing at a neighbourhood level.
There has been much discussion about whether this is a moment for the health service to reset, recover or restart. Yet how we describe the next phase of the pandemic is less important than the principles that underpin it.
Across the healthcare system, we must learn from and build on our experience of the last year – working in new ways, innovating and developing local solutions, collaborating across the system and using our patients and the public as our assets. We should not lose the opportunity to ensure that we emerge with a renewed focus on the health and wellbeing of staff, real action on health inequalities, and protection of the collaborative working that will underpin future system working.
We have been talking to primary care leaders about their challenges and what they need to deliver services safely and sustainably. Their insights point to three key issues that must be front and centre of the health sector’s planning as we enter the next phase of the pandemic.
1. Building back better and different We must take this opportunity to finally make the paradigm shift to population health management that has long been needed. This will require more seamless pathways between primary and secondary care rather than transactional hand-offs. We will need to adopt a system and place-based approach to common problems which put the patient at the heart of our response. There is a risk that as pressure builds, people revert into silos. That would be the wrong approach. We need to capitalise on the opportunities that working as part of new integrated care systems present.
2. Setting priorities and managing public expectations Primary care faces rising demand, growing complexity, higher expectations, increased administrative burden and the continued challenge of rolling out the largest ever vaccination programme in the UK. Yet public debate is mainly focused on the pressures facing hospitals. This needs to change. A key requirement is setting clear priorities and being open with the public about what is achievable.
3. Investing in infrastructure Primary care provides huge numbers of high-quality consultations, but outdated infrastructure holds back progress. New services based on patients’ needs are being set up, but more could be achieved by expanding the primary care workforce and creating more space within primary care premises. The government needs to invest in management support, estates, IT and digital solutions to unlock the full potential of primary care. This needs to be accompanied by more regulatory permissiveness that empowers primary care professionals to get on with the task at hand.
Above all, we need to support primary care staff to recover so that they can best support their local communities. We cannot underestimate the challenge ahead for primary care, with an increasing and more complex workload, a tired workforce and the ongoing vaccination programme.
These issues are felt right across the health and care system and this reinforces the opportunity to tackle them together. Integrated care systems and integrated care partnerships have the potential to bring clinical leaders and managers together across providers to design solutions that protect services for those who need them, enable a more proactive approach to keep people well and locks in a more innovative and permissive culture.
Some might argue that emerging from the height of the pandemic is an unhelpful time to seek change; others will share the view that we can look for opportunity on the back of adversity.