NHS Voices blogs

We're going to need a bigger boat

Navigating uncertain seas to reach the longer-term vision for primary care.
Dr John McGrath

18 September 2023

With Professor Claire Fuller’s appointment as the new medical director of primary care at NHS England, Dr John McGrath reflects on where general practice and primary care are headed, and how we might navigate the journey.

For millennia, travelling the worlds’ oceans has offered adventure and peril.  Long before the advent of global positioning satellites, seafarers have used Polaris, the North Star, to aid navigation. Change was incremental. Maps, compasses, sextants, chronometers all played their role to solve the puzzles of latitude and longitude. But the certainty of a fixed point in the sky gave constancy when all else failed.

…no matter the size or shape of our boat … the sea is the same for all

Our healthcare landscape can feel similarly murky and uncertain. The shifting political tides, the terrifying pandemic storms, the doldrums of policy implementation. Through it all, providers of healthcare bob along in our vessels of varying sizes. In primary care, our challenges are well documented and no matter the size or shape of our boat, whether we are sailing alone or in a flotilla, the sea is the same for all.

Understanding the detail to find solutions

Understandably, we can often focus on our own needs, especially where these are urgent, and concentrate on our differences – whether these are contractual, financial, demographic, technological or social. The detail here is essential and needs to be understood fully in context to find tailored solutions. A common local frustration is where one feels one has not been heard. A challenge for national teams is to find flexible enough responses.

There is much binding us. The enormous value of primary care, including general practice, is in our shared values. The commitment to people in place with emphasis on wider aspects of health, wellbeing and equity are palpable. Research that puts a figure on return on investment of £14 per pound spent does not feel surprising to those who work in it.

A vision statement for primary care

Individuals and their organisations at the forefront of primary care are creating and sustaining change, working with myriad local stakeholders and collaborators, transforming not just the health but the lives of local people and their staff. Where this is most powerful, we see general practice working with their communities and their local colleagues, whether these be health or not, statutory or other.

If integrated care systems are to be successful in their intended role to progress wider societal development, this can only come with leadership from those closest to that society

In doing so, the potential to address the issues of widening health inequality becomes more possible. If integrated care systems are to be successful in their intended role to progress wider societal development, this can only come with leadership from those closest to that society. In turn, the solutions to the challenges in general practice are likely in part to come from combined action in primary care and the wider system. It is thrilling to see these tenets reflected in the NHS Confederation vision statement for primary care.

In my various job roles, I have lived life from a commissioning perspective at a time of great change into integrated care systems, worked as a provider in different parts of our NHS system, and worked with practices and PCNs wanting to deliver improvement initiatives. If nothing else, this has given me a range of perspectives. In many areas, general practice and primary care looks very different to a decade ago. In others, things look more perilous than ever. Strategies, policies, foundational pillars have been plentiful, even if at times resource has been less easy to find.

The question is how we together solve the puzzles we face navigating the health and care landscape. As new treatments and technologies become available, as the passengers on our metaphorical boats change and age, as our crew numbers wax and wane, it becomes harder to see the way forward. Current financial challenges and intense workload pressures further obscure our view.

the great strength of primary care is its ability to be responsive to those changing circumstances

The vision statement commits to support primary care to ‘thrive in all its forms’. This seems key, as the great strength of primary care is its ability to be responsive to those changing circumstances. To stretch the metaphor, whilst different boats are best placed to do specific jobs, the key components of what will float and not have been tested over time. Just as ship design evolves, these models will and must change, but it is very unlikely that a single craft will be fit for all seas.

If we accept this, given this how different we all are, how far back do we need to zoom to get to that shared purpose that gives direction in these uncertain times? For mariners, the North Star was never the destination, but simply a way to get to where they are going.  The vision statement sets out an ambitious longer-term vision for primary care, one that builds on the work spearheaded by Professor Fuller before taking up the director for primary care role. Now the challenge thrown down to all of us is to deliver it. Whilst the task is large and the seas rough, the opportunity is there to act with purpose and at scale.

To paraphase the movie Jaws, we’re going to need a bigger boat.

Dr John McGrath GP, Clinical Faculty NHSE Primary Care Transformation Team is co-clinical lead for NHSE London Virtual Wards. You can follow John on Twitter @drjmcgrath