In this blog by PCC’s chair Professor David Colin-Thomé, David revisits the Primary Care Home model which was designed to level up quality and increase the range and scope of primary and community service provision. It was intended to significantly contribute to reshaping hospital services and to have a central role in health and wellbeing beyond healthcare by developing a local public health for primary care. David considers the relevance of this work to where we are now as the 10 Year Health Plan is implemented.
David Colin-Thomé
I have been asked to expound on the relevance of the Primary Care Home (PCH) to the NHS 10 Year Health Plan. I will frame this blog around the excellent recent blog from PCC Governor William Greenwood-The next decade for general practice and primary care.
To recap I originated the PCH concept at the tail end of my ‘czardom’ at the Department of Health in 2009. My imperative for primary care was for it to be indispensable to future NHS transformation even beyond its existing importance, and to ensure its ongoing centrality to all facets of the NHS. The ambition – with acknowledgement to Donald Berwick’s learned work- a specific triple aim for primary care. To level up quality and increase the range and scope of primary and community service provision – To significantly contribute to reshaping hospital services which acute providers and commissioners have failed to do – To have a central role in health and wellbeing beyond healthcare by developing a local public health for primary care. The National Association of Primary Care was enamoured by the concept and brilliantly developed it so well that it became the precursor to Primary Care Networks (PCN). A vivid example of grass roots ideas influencing national policy. The current policy- ‘At its core, the Neighbourhood Health Service will embody new principles – that care should happen as locally as it can – digitally by default- in a patient’s home if possible – in a neighbourhood health centre (NHC) when needed – in a hospital if necessary’. In essence a welcome enhancement of PCH, but unlikely to be delivered until there is ownership by community based clinicians, with list based primary care at its heart. To emphasise localism and foster innovation in a must be retained general practice, PMS contracts should remain an alternative to the often stultifying GMS contract. All achievable by working cohesively with national policy makers, echoing the successful implementation of the age old policy of GP Fund Holding. A policy that enabled GP volunteers to shed the controlling bureaucracy and in turn influenced ongoing policy. With PCH the involvement of the full range of community based professionals ensured its national influence.
On critiquing William’s blog, I feel it implies even more government action is required when previous failures predominantly were a consequence of the NHS lacking the desire for change and passively blaming everybody but us. The present plan encompasses the policy I’ve been hoping for throughout my career, and its policy development must primarily be led by the service. ‘Leadership across cultures’ equally applies to working appreciatively with policy makers. When working at the Department of Health I was described as mediating well between politics and the service- for some praiseworthy, for others less so! I have recently read a doctorate thesis on nursing leadership where the difficulties of hybrid working – in this case being both a practicing nurse and manager- is writ large. To succeed you need to be coherently aligned with both cultures. Equally so working with government whose role is difficult and literally thankless. There is little money, the NHS has been treated better than most and urgently more must be spent on defending our country – a government absolute. I have consistently believed that the budget you finally receive is the correct one, especially given the enormous percentage of government spend the NHS receives. So, we should just get on with it. As Abraham Lincoln said, ‘the core purpose of government is doing for the community what individuals cannot do well themselves’, so why isn’t the necessary drive to improve coming from within the NHS at all levels? The latent talent is there, and I’ve cited two examples of GP leadership where the abiding culture was of trust and enablement- not a common NHS attribute.
Which brings us back to PCH necessarily briefly as each item is blogworthy. Emanating from work in ‘my’ general practice, subsequently developed at a locality scale- at the request of the most primary care empathetic and policy developer NHS Chief Executive Simon Stevens – to render PCH of more strategic importance. A perfect fit for neighbourhood health and given the policy shift away from hospital centricity, a necessary framework for all levels of NHS authority. Developing and expanding primary care is an evidence based approach to improving the health of the public (Starfield, Berwick, Roland et al). Involving all community based services and the public will herald a healthy and well being centricity. To improve the public’s health all community services working with local authorities and private, public and charitable organisations to deliver at long last locally on the Marmot report (2010) as the NHS alone has an important but a minority role., And crucially if the NHS is to live within its resources and provide the essential increased resources to the community, the hospital sector must be transformed. Achievable with purpose building on the publication channelling the Royal Proclamation, ‘The hospital is dead, long live the hospital’ (Corrigan et al). The NHS indeed could have delivered all this without perennially waiting for government.
Professor David Colin-Thomé is chair of PCC.
For support to develop neighbourhood working and collaborative leadership, contact enquiries@pcc-cic.org.uk or visit www.pcc-cic.org.uk for more information.
