Streamlined access, personalised care and a joined-up approach to prevention are essential components of providing integrated primary care, the report says
"We are going to need to look beyond a traditional definition of primary care and understand that NHS urgent care is what patients access first in their community – typically from their home or high street and without needing a GP referral.” Dr Claire Fuller, author of Next steps for integrating primary care
Previously siloed teams and professionals need to be brought together to provide more integrated care for patients, according to a new review by Dr Claire Fuller.
The review, ‘Next steps for integrating primary care: Fuller stocktake report’, was commissioned by NHS England and NHS Improvement. Its brief was to identify what was working well in integrated primary care and look at how to speed up implementation of integrated primary care across the health service. Fuller interviewed approximately 1,000 people in the health sector for the review.
The review focuses on three broad outcomes:
At the heart of the vision for integrated primary care, the report says, is the need to bring together “previously siloed teams and professionals to do things differently.” This would be “most powerful” in neighbourhoods of 30-50,000, where teams from across primary care networks (PCNs), wider primary care providers, secondary care teams, social care teams, and domiciliary and care staff can work together to share information and resources. The “philosophy of partnership,” Fuller writes, is “at the heart of my report.”
The creation of multi-organisational and sector teams working in each community will “help individual PCNs and teams better manage demand and capacity, building resilience and sustainability,” the report says.
ICSs have an opportunity to use their scale and combined power to develop relationships between sectors. This integrated working, the review says, “offers the NHS a real opportunity to deliver more effective and sustainable change.”
Fuller notes that the two issues dominating debate throughout her review were the need for people to access same-day urgent care and the need for GPs to be able to provide continuity of care for patients who need it most.
Describing these issues as “two sides of the same coin,” the report adds: “We are going to need to look beyond a traditional definition of primary care and understand that NHS urgent care is what patients access first in their community – typically from their home or high street and without needing a GP referral. As part of accessing urgent care, a patient may then get immediate referral into emergency care or go online to talk to somebody before walking into a hospital emergency department.”
Patients with chronic conditions may need or want continuity of care, while others are happy to be seen by any appropriate clinicians as long as they are seen quickly. “Managing access for multiple services at a practice level is achievable and scalable if we create the right conditions for this to happen,” the report says. That includes “working together to make better use of capacity and workforce.”
Fuller says that primary care has an essential role to play in tackling health inequalities and preventing ill health, and must work in partnership with other systems on prevention and management of long-term conditions. She identifies three areas where primary care is taking a more active role in reducing ill-health: “working with communities, more effective use of data, and through close working relationships with local authorities.”
The use of digital and technology throughout the pandemic has helped us develop our belief in their role in healthcare, Fuller continues, noting that “more and more people want to use apps and mobile devices to support their healthcare.”
Demand on primary care is at an all-time high – in March, general practice saw 30m appointments. The consequence of such demand is that GPs are overworked and demoralised, while patients are dissatisfied. Part of the answer is likely to be a more integrated approach in which patients receive care from the right person at the right time. Fuller’s focus on streamlining access to care, providing more personalised care from multidisciplinary teams, and taking a joined-up approach to prevention is therefore the right one.
Fuller believes the new integrated care systems are well-placed to achieve these aims. We agree with her, but they need to funded adequately and backed by a robust workforce plan from government. Without the right workforce, the integrated approach envisaged by Fuller will be impossible to achieve.
As Fuller observes, technology has played a vital role in care provision during the pandemic. It is essential that a strategic approach is taken for both access and continuity with digital referrals. Moving between primary and secondary care needs improvement and a specific plan for technology is yet to be described in detail.