The ‘Next steps for integrating primary care: Fuller Stocktake report’, calls for general practice to be better integrated with other parts of the health and care system to improve access to services and offer regular support to those with complex needs.
Dr Claire Fuller’s review, was commissioned by NHS England to assess how newly formed Integrated Care Systems and primary care could work together to improve care for patients.
Dr Fuller, a practising GP, engaged with around 1,000 people across the health sector and has said there should be:
• Better access to urgent primary care services for patients – ensuring people who need it can be assessed on the same day and offering more choices to those who do not regularly use health services.
•Improved support to patients who need ongoing care by combining primary care and community teams and ensuring they see the same clinicians on a regular basis.
• Help to make people live well for longer by working with local government and the voluntary sector to seek out people who need more support before their health problems escalate.
The report states: “The truth is, we can create a much better offer for all our patients, but it requires effective collaboration across primary care and with the wider health system in a way that we have not managed to date.”
And: “We should start by recognising the current system is not fit for purpose - it is fragmented and causing frustration among patients and staff. In the face of rising demand, we need to move to a streamlined and integrated urgent care system - and primary care has an essential role in achieving this. We need to enable primary care in every neighbourhood to create single urgent care teams and to offer their patients the care appropriate to them when they pop into their practice, contact the team or book an online appointment.”
Improvement support, data and leadership are central to making this work. Connecting up the wider urgent care system, providing support to organise the currently separate and siloed services into a single integrated urgent care pathway in the community that is reliable, streamlined and easier for patients to navigate, is vital.
The critical role of estates
Estates is one of three areas detailed in the review with the most potential to make a significant impact, with the right approach, to create a national environment to support locally-driven change. Workforce and data are the other two.
The Stocktake report calls for a detailed review of the space available in each primary care system, service by service, which will inform the ICS estates infrastructure strategies. “These reviews should help us understand what we have got and what we can fix locally, as well as help us prioritise funding as and when capital becomes available.”
ICSs are able to take a ‘one public estate’ approach and think creatively about primary care estates. They are able to consider developing primary care estates plans from the perspective of access, population health and health inequalities, part of which should be to seek opportunities for co-locating primary care when bringing forward secondary care estates plans as well as repurposing existing space within local funding streams and making creative use of void and vacant space in the NHS Property Services and Community Health Partnerships portfolio.
NHS Chief Executive, Amanda Pritchard, will now work with colleagues across the system to implement the recommendations.