GPs may soon see urgent same-day appointments being dealt with by ‘single, urgent care teams’ across larger populations following proposals put forward in a major NHS England-commissioned review.
Dr Claire Fuller, who is the chief executive of an Integrated Care System (ICS) in Surrey and a GP herself, published her report today on integrating primary care with other NHS services.
Her main recommendations came around ‘enabl[ing] 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’.
This would require a shift in national policy towards 111, she said, and organising a ‘single integrated urgent care pathway’.
Dr Fuller said: ‘Left as it is, primary care as we know it will become unsustainable in a relatively short period of time.’
She also laid out plans to develop ‘innovative employment models such as joint appointments and rotational models’ to counter the GP workforce crisis, and change the way GP premises are owned and managed.
The report said that primary care ‘urgent care teams’ must ‘connect up the wider urgent care system’, including ‘currently separate and siloed services’ such as general practice in-hours and extended hours, urgent treatment centres, out-of-hours, home visiting and 111 call handling and clinical assessment.
They must ‘organise them as a single integrated urgent care pathway in the community that is reliable, streamlined and easier for patients to navigate’, it added.
NHS 111 ‘can often result in duplication of effort for patients, carers and clinicians’, the stocktake heard, as there is currently no ‘clear and consistent way of counting and measuring same-day urgent access or unplanned waits for routine appointments’.
The report suggested NHS England should develop a way to do this, in connection with its ‘wider work with systems in bringing together a set of key primary care standards’.
It also set out ways ICSs can be ‘flexible and nimble in managing the broader workforce’ to provide some ‘quick wins’ to tackle workforce pressures.
It said: ‘Systems should also support the development and rollout of innovative employment models such as joint appointments and rotational models that promote collaboration rather than competition between employers, particularly where skills are scarce.
‘To support improved workforce planning, the electronic staff record or a similar integrated workforce solution should be used throughout primary care to inform demand and capacity planning and enable team-based job planning and rostering to become the norm.’
On GP premises, the report said the Department of Health and Social Care (DHSC) and NHS England should give ‘additional, expert capacity and capability to help offer solutions to the most intractable estates issues’.
It said that the ‘GP owner-occupier model includes perverse incentives which can make cross-system collaboration more difficult’.
The report recommended that ICSs ‘develop a system-wide estates plan to support fit-for-purpose buildings for neighbourhood and place teams delivering integrated primary care, taking a “one public estate” approach and maximising the use of community assets and spaces’.
And in ‘last partner standing’ scenarios, ICSs might consider transferring estates ‘ownership to public or commercial system partners’ when GP partnerships propose handing back their contracts, it said.
NHS England and the DHSC should review ‘what flexibilities and permissions should be afforded to systems’ to allow ‘shaping and influencing of the physical primary care estate’, as well as reviewing the Premises Cost Directions, the report said.
The DHSC should also make sure primary care estate is a key part of the next iteration of the Health Infrastructure Plan, it added.
The report also said:
- The ‘primary driver of primary care improvement and development of neighbourhood teams in the years ahead’ should be ‘system leadership’
- ‘Every effort should be made to create as much local flexibility around discretionary funding as possible’, beyond DDRB and pay uplifts after 2023/24
RCGP chair Professor Martin Marshall said ‘further detail’ is needed about the ‘proposals around streamlining urgent access’.
He said: ‘Any new metrics will need to be thought through carefully so they have a positive impact on patient care and avoid any duplication or perverse incentives across the system.’
However, he added that the report is ‘appropriately ambitious given the scale of the crisis in general practice’ and that the ‘explicit support of the new chief executives of the ICSs for the report is positive’.
‘ICS leaders have a significant responsibility to ensure that general practice and primary care receive the support and resources that they need to be the foundation of a reformed NHS,’ he said.
BMA England GP committee chair Dr Farah Jameel said it is ‘refreshing to see Dr Fuller’s honesty about the scale’ of the workforce and workload challenges facing GP practices and the report’s ‘bold suggestions on how to begin to address this’.
She said: ‘This stocktake clearly lays out a desired direction of travel for care in our communities, setting a vision for what good looks like in primary care – while recognising the challenges and need for movement from Government and NHS England to fix the issues around workforce, estates and digital infrastructure.
‘Ministers and policymakers must now take heed – listening to, supporting and working with GPs and their colleagues to ensure they can provide the standard of care that all patients deserve. As ever, general practice stands ready to play its part and will continue to deliver for its communities.’
Dr Jameel also welcomed the report’s findings that GP ‘autonomy is far more valuable in improving outcomes for patients than top-down directives and micro-management’.
ICSs are due to become statutory organisations in July, and will replace clinical commissioning groups.
GP Dr Claire Fuller was tasked by NHS England to look at the ‘next steps’ for how PCNs will work in ICSs via a ‘stock-take’ in November.