When I read this stocktake admittedly rapidly, I thought a ‘same old’ NHS document in which as usual primary care must be subsumed into a faceless big is beautiful bureaucracy.
By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.
When I read this stocktake admittedly rapidly, I thought a ‘same old’ NHS document in which as usual primary care must be subsumed into a faceless big is beautiful bureaucracy. On a more thorough read I was wrong and feel it a positive contribution respecting what primary care has achieved, and the opportunity for it to be a real leader in improving the ailing NHS.’ It is vital that we retain continuity as one of the core strengths of primary care’ and ‘Primary care has always had an entrepreneurial and innovative spirit’. And as for the new world of Integrated Care Systems (ICS) etc- ‘Primary care must be at the heart of each of our new systems’. Easy to say but uncommon to find in traditional NHS documents especially one commissioned by the NHS chief executive who like all but the last incumbent, come from an acute care background
Further ‘In my view, ICSs come just at the right time, tasked with achieving four aims: improving outcomes in population health and healthcare; tackling inequalities in outcomes, experience and access; enhancing productivity and value for money; and helping the NHS support broader social and economic development. The ICS CEOs believe that achieving these aims will only be possible if we support and develop a thriving integrated primary care system. This will need to be built as locally as possible, drawing on the insights, resourcefulness and innovations of patients and their carers, local communities, local government and NHS teams, other care providers and wider system partners, as well as, of course, primary care leaders. This philosophy of partnership is at the heart of my report’. The aims are not new by any means but the reported ‘buy in’ of all ICS chief executives (CEOs) is a first for all senior managerial leaders in my long experience as a clinician and a senior NHS and Department of Health person. Dr Fuller who has a similar wide experience has achieved a hugely commendable consensus. And being a public statement, lends itself to holding CEOs and other senior officials to future account.
And there is more- ‘Integrated neighbourhood ‘teams of teams’ need to evolve from PCNs. I have a long time commitment to localism in an otherwise large impersonal NHS. It is an essential responsibility of all organisations to act locally and yet be strategically important. These comments reflect a thread linking the Primary Care Home that I first described in 2009, brilliantly developed by the National Association of Primary Care and supported by then NHS chief executive Simon Stevens that culminated in primary care networks (PCNs).
And refreshingly, ‘This requires two significant cultural shifts: towards a more psychosocial model of care that takes a more holistic approach to supporting the health and wellbeing of a community; and realignment of the wider health and care system to a population-based approach – for example, aligning secondary care specialists to neighbourhood teams.’ I have long contended that health is about feeling good about yourself rather than only the narrower reductionist ‘lack of disease’ view of health. A locus of control and an absence of poverty are essentials for good heath at individual and community level, superseding at a population level even disease prevention and treatment of illness when measured for health outcomes. Of course, for affected individuals, care and treatment is the essence of the clinician’s role. Only building on list based primary care as committed in the NHSE Five Year Forward View (2014) can all this be achieved, and fully recognised in the Fuller stocktake ‘The successful delivery of the new model can only be optimised if systems ensure they bring GP practices of all different shapes and sizes with them. We need to recognise that maintaining stability in general practice will be central to being able to deliver the new model of integrated care’. General practice is the only NHS provider to have an enshrined population responsibility.
We need to commit to the current development as ‘We should start by recognising the current system is not fit for purpose’. A bold and possibly controversial comment to which I subscribe and consequently have consistently supported NHS and wider system reform. The stocktake is just that, a taking of stock, but the message is clear as to me it always has been – do not abdicate sole responsibility to government and then complain about the ensuing policy. It is up to all of us to be the policy developers by utilising the vehicle of change being offered. The Fuller stocktake is of great value but only if it ensures the commitment that is seemingly promised, of ‘buy in’ by current senior leaders and thereby enable local services to have a locus of control. The best leaders keep control by letting go.
