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Opinion: Call for realism in a ‘policy-rife’ world

Opinion: Call for realism in a ‘policy-rife’ world
By Dr Nicole Atkinson
10 March 2022

The pandemic pressures are easing and with that, reform is high on the agenda as the Government seeks to assert a legacy that is more than Covid-19. That’s a good thing – having worked in primary care for two decades, most GPs will tell you the NHS needs reforming. 

The priorities within primary care have had to radically shift in response to the changing and expanding vaccination requirements and other Covid demands. This has resulted in an exhausted workforce and huge backlogs of care – and that’s just of the patients who have made themselves known. 

There is a danger that ambitious and well-intended political ideology will run ahead of the reality on the ground within primary care, leading to raised public expectations and a disgruntled and confused – or worse, disengaged – workforce. 

We already have the Health and Care Bill making its way through Parliament, as well as a white paper on integration, a recovery plan for elective care, a stocktake of primary care’s role within systems, and the NHS Long Term Plan. 

While trusts and ICSs focus on their planning guidance, primary care teams are now working through the latest GP Contract, which shifts the focus away from vaccinations back onto long-term condition management and chronic disease control. What next and how do these policies all link together? This is a lot for leaders to keep up with alongside the day job. 

Three things are needed in this policy-rife world the NHS finds itself in: coherency, realism and adequate resourcing.

On coherency, there is a risk that the NHS frontline is overloaded with overlapping and potentially competing strategies while grappling with its recovery challenge and the threat of a resurgence of Covid. We know that over six million people are waiting for an elective procedure, over 1.6 million people are waiting for specialised treatment or support for their mental health, and we have a huge job across primary care in recovering long-term condition management. It’s right that we look ahead but we need to recognise where we are now and make sense of all the seemingly disconnected parts, combining practical things the NHS needs to get on with doing, with the longer-term vision that all parts of the system can sign up to. 

On realism, proper recognition – beyond warm words – is needed of everything the NHS, including primary care has been through over the last two years and what Covid is leaving behind. Figures show that there are over 110,000 vacances across the NHS in England currently and primary care is feeling this too. The Government promised the electorate an additional 26,000 primary care staff, including 5,000 GPs but two and a half years into primary care networks, many of these additional non-GP roles are not filled – this is despite everything PCNs are doing. Separately, we are also woefully short on the promised numbers of GPs. The GP Contract for 22/23 offers a bit more flexibility around the recruitment of mental health practitioners but this needs to go further, while accepting the fundamental workforce deficit all parts of the NHS are contending with.

On resourcing, the Policy Exchange was right to recently impress the need for a ‘rescue package’ for primary care supported with additional investment. Primary care does need modernising and both integration and economies ‘at scale’ have to be the way forward in response to rocketing demand, more complex need, and workforce and infrastructure gaps. This means giving the sector the flexibility and support to redesign services, including through its PCNs and GP federations, with their local communities in mind.

As a GP, the last two years have been perhaps the hardest in my career, but they have also been the most rewarding. The pandemic has brought rapid change and innovation across the health service, and primary care has consistently shown what it can achieve – whether through its agility to deliver almost overnight a total triage model of care, support virtual wards, or work in collaboration to administer millions of Covid vaccinations.

The future of the NHS is not about reinventing the wheel but about building on this integration and success, while providing the tools that enable the service to grow and thrive.

Now is the time to ensure primary care is front and centre of the NHS’s transformation and recovery plans and that it is enabled, supported, and invested in to deliver. Let’s work together to design and create a sustainable future for the sector, and ensure it remains at the heart of our NHS.

Dr Nicole Atkinson is a Medical Adviser for Primary Care, NHS Confederation and clinical lead, Nottingham and Nottinghamshire Integrated Care System.

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