A stronger, reinvented model of primary care will be as central to the NHS’s next 70 years as it has been for the last 70. By Michael Macdonnell
This year there will be about 300 million GP appointments in England as compared with 15 million hospital admissions. The total average annual cost of delivering primary care to each person is about three quarters of the cost of one outpatient appointment. I once heard primary care compared to the processor in a computer: you may not always remember it’s there, but the machine wouldn’t work without it.
In fact, this understates the importance of primary care to the NHS. Primary care has been the cornerstone of the NHS since its inception. It will be even more important to its future. The future NHS will collaborate rather than compete, operating as local systems capable of meeting the systemic challenges that face it, including winter pressures.
The most mature areas will go beyond system working and integrate their services around those patients who are most likely of becoming acutely unwell. The job of integrated systems is to get upstream – and this cannot be done without strong primary care.
This means more investment. Funding has been steadily increasing from less than £9bn annually in 2013-14 (when NHS England was established) to over £10bn last year. It will rise to over £12bn by the end of the decade.
Of course, this hasn’t resolved the pressures on primary care not least because we are losing GPs faster than we are training them, something we have got to fix. And as with the rest of the health service, the demand on GP surgeries continues to rise even if this isn’t recognised by the media as readily as it is in hospitals.
The job of integrated systems is to get upstream – and this cannot be done without strong primary care
But investment needs to be matched by an evolution in how primary care works. Our leading integrated care systems tell us this evolved model has five features.
Five features of an evolved model
First, it will operate at greater scale, in networks covering 30-50,000 population or more, building on the link practices have with their community. By working together, practices can share workforce, assets and interoperable IT.
Second, these networks will offer enhanced access and expanded services, including some outpatient and diagnostic services traditionally provided in hospitals. Third, they would deploy pharmacists, nurses, mental health therapists and other professionals, working together in integrated teams. The most advanced practices may also collocate or otherwise collaborate with social care, other services provide by local government and by community groups.
Fourth, primary care networks will provide proactive services aimed at keeping people well and out of hospital. Taken to their logical extension, proactive care means, fifth, reconnecting GPs and consultants and joining up teams working in surgeries and hospitals.
The task is to spread these models systematically and widely
This future is already here. In Greater Manchester, 486 practices are clustered into 50 hubs that are focused on the health of their population rather than just those who walk through their doors. They have separated urgent from planned care, enabling GPs to provide more support to people with chronic diseases.
In Dorset, multidisciplinary teams meet in all practices to identify those most at risk of hospitalisation, with integrated “complex care” teams on hand to help. This has resulted in a 10 per cent reduction in acute bed days for people over 65s and a reduction in unplanned admissions.
In Blackpool, “extensivist” teams work out of two hubs with their hospital colleagues, providing continuity of care whether at home or on a ward, with the aim of preventing people from spending unnecessary time in hospital. The result: an 11 per cent reduction in accident and emergency attendances and a 17 per cent reduction in non-elective admissions.
The task is to spread these models systematically and widely. This won’t be easy, and it will require investment and more staff. But our leading systems show us more of the same shouldn’t be the aim. A stronger, reinvented model of primary care will be as central to the NHS’s next 70 years as it has been for the last 70.