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Managing changes in primary care as an ICB

Managing changes in primary care as an ICB
By Sam Hepplewhite Director of prevention and partnerships at South East London ICB
1 February 2023

The current pressures on the NHS are well documented, and in South East London ICB we’re very similar to the rest of the country in that we are seeing real pressure in general practice.

Everything that we are asking of them puts them in a unique position. They are often seen as the first port of call for many people in the community; they still have a high level of competence and trust.  

And we are asking them to do more and more work in the community. There’s been a huge amount around vaccine programmes, with COVID, flu and immunisation for children running concurrently. We’ve also had polio and MMR programmes.

On top of that, the role of primary care is changing. And that puts significant pressure on the workforce. While we’re seeing less of a problem with recruitment, there are other challenges. The main ones are retention and the environment in which people work.

New roles in primary care

We have worked with Skills for Health (see box) on supporting our PCNs to develop long-term workforce plans. There have been examples where primary care networks (PCNs) have recruited to a new role and then thought: how do we integrate them into the workforce?  But you can’t expect a role that’s never been part of primary care to be lifted, shifted into that new team, and for it to work immediately.

Primary care is completely different to working in other parts of the NHS. You don’t have that massive infrastructure of support that you do in a hospital – you’re often working on your own. From an individual’s perspective, that can be tough. If you’re the only paramedic in a PCN or the only first-contact physio, that’s quite a lonely place to be.

The length of time it takes to integrate new roles into a team is one weakness in this scheme. That can affect service delivery. PCNs vary in their maturity and capability to make some of the necessary decisions. There is also an element of preparing the public for all these new roles, which needs to be factored in.

Communicating changes to the public

For example, you wouldn’t traditionally see a paramedic at your GP practice. Some practices have never had physios in their practices, either. More could have been done nationally to say that your primary care and general practice teams might look different.

Five years ago, when someone saw a GP or a practice nurse, they might think that was the entire primary care workforce.  And so now people struggle to understand why they are seeing somebody else. They wonder why they are being diverted to someone who is not a GP. 

It is a challenge to provide that information to the public in South East London, as I am sure it is in other areas. It can be difficult to communicate that on this occasion, if you go with this condition, you might end up seeing this particular professional – and reassuring them that it’s okay.

A cultural shift

The changes bring challenges for clinical teams in general practice too. They recognise that they might have to let go a little bit.

GPs will have to work differently. They really cannot continue to absorb all of the demands coming their way – there will be other professionals that can help them with that. And we have to provide them with the confidence that they can trust some of these other professionals.

That won’t be in every practice or every PCN, of course. For GPs, general practices and PCNs, it is important to work out what their future operating model is going to look like.

There will be a cultural shift. And when it comes to general practice in primary care, this has not always been done well. The same goes for the public – we need to take them on this journey with us. We need to help them understand that general practice and primary care teams will look different.

Changes to the primary care model

As well as this cultural shift, the interface between acute services, community health, mental health and the voluntary sector will make primary care more sustainable. In other words, those relationships within the wider system are going to make a real difference for our residents.

Recruitment and retention is the other key to ensuring a primary care workforce that is fit for the future. It will be much more rewarding because you can look after that individual in front of you rather than having multiple handoffs and negotiating the system yourself.

The general practice model is going to evolve. Hopefully, general practice and PCNs will shape those changes – and it won’t be because we have a new contract in place or we’ve been told that’s what we must do. Instead, the workforce will adapt to meet the needs of modern healthcare.

How Skills for Health supported South East London ICB

Skills for Health has supported South East London ICB (SELICB) in developing strategies and approaches for integrating the workforce across the Integrated Care System.

SELICB was looking to build workforce planning capacity and capability across primary care networks (PCNs) and develop a sustainable workforce planning model to meet long-term demand.

A key objective was to develop the first iterations of PCN-level workforce plans and help those working across primary care to better collaborate with a broad range of stakeholders across the six boroughs and the Integrated Care System as a whole.

Skills for Health enabled PCNs to think, discuss and build relationships to develop a long-term approach to workforce planning. So now, PCNs are thinking about what an integrated workforce plan might look like – and that goes much wider than general practice. They are considering integrated neighbourhoods, mental health, and acute and community services.

Sam Hepplewhite is director of prevention and partnerships at South East London Integrated Care Board.

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