A licence to act for progressive primary care leaders
As the final report draws near, Matthew Taylor highlights our members' views on what the stocktake should include.
Surrey Heartlands integrated care system (ICS) lead Dr Claire Fuller is to be commended for the lengths she has gone to engage a wide group of stakeholders in the preparation of her primary care stocktake. This is intended to understand how ICS leaders can support better primary care integration.
Indeed, I hear that she now has something of a challenge to accommodate all the ideas developed in the many meetings and subgroups established to guide her work.
The work places strong emphasis on the role of ICSs in renewing and supporting primary care in systems, places and neighbourhoods.
As the report publication date draws near, our members across both primary care and ICSs have highlighted a number of key issues they hope to see addressed in the stocktake.
...the report should emphasise how renewing primary care is integral to the core tasks of ICSs, particularly in relation to addressing and improving population health
Crucially, it will be important to avoid any sense among system leaders that the stocktake recommendations are just another set of items to add to the ever-growing list of central priorities. Instead, the report should emphasise how renewing primary care is integral to the core tasks of ICSs, particularly in relation to addressing and improving population health.
The stocktake should articulate how the work of neighbourhood multidisciplinary teams can bring together data across health and care to map health needs and inform local models of care and proactive resource planning for population health management at neighbourhood, place and system level. This will also help build the expertise to drive community-led solutions to system commitments, to tackle health inequality and move resources upstream.
Licence to act
It is vital that the stocktake is seen not so much as driving change in primary care, as enabling it. Primary care networks are the building blocks to ICSs and there is a necessary relationship between those who can empower system partners to improve: ICS leaders, and those capable of driving the change: primary care leaders. There is a huge amount of innovation and ambition in primary care and the stocktake needs to feel like a licence to act for progressive primary care leaders.
Investment in primary care capacity will also be key. Whilst primary care has benefitted from additional investment through a five-year deal, we cannot ignore the need for investment in the underlying capacity of primary care in areas like organisational development and leadership training, back-office support, equipment and estates.
If the right investment is made in the short and medium term to help meet patient demand and COVID-19 recovery, it is possible not only to plot a route to a financially sustainable model of primary care, but also to show how primary care can reduce cost pressures in the rest of the system.
Given the insight, enthusiasm and goodwill that has built up, it will be important to see this report as merely a milestone on a longer learning journey of change
The evidence from both public policy and organisational strategy suggests progress is most likely to be achieved – and to stick – when it combines and balances drivers that are top down, including strategy and resources; lateral, including culture and the values of professional ownership; and bottom up, including individual aspirations and population based.
Inevitably, in a complex fast-changing context, some elements of the stocktake will move forward more smoothly than others. Given the insight, enthusiasm and goodwill that has built up, it will be important to see this report as merely a milestone on a longer learning journey of change.
At a recent dinner hosted by the Royal College of General Practitioners there was, among the 60 or so distinguished attendees, a high degree of consensus about the direction of primary care reform. The question is not so much about the destination as the route there, and what will be needed to sustain the journey.
This article first appeared in HSJ on 10 May 2022.
Matthew Taylor is chief executive of the NHS Confederation. You can follow Matthew on Twitter @FRSAMatthew
