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Ruth Rankine, director of the primary care network at the NHS Confederation, shares her thoughts on the Fuller stocktake, which was published a year ago tomorrow.
If you were to summarise the post-Fuller stocktake implementation in a word, it would be ‘mixed’. That may seem like an obvious response but it’s the reality; the variability of the implementation process across local and national is something we are very clearly seeing as part of our work as a network. But there is cause for optimism.
NHS Confederation was very supportive of the overall vision of the Next steps for integrating primary care: Fuller stocktake report and its recommendations, which sought to tackle many of the core challenges and opportunities facing primary care. Our members regarded it as sensible, and because it was effectively a ‘stocktake’ of what already existed, it chimed with what they were trying to do and striving for locally. The buy-in from all 42 ICS’ was significant and it showed ICS leaders as truly leading the way for the new direction of integrated working.
However, as is the nature of these things, there is variation as systems work through competing priorities. Undeterred, many systems are just ‘getting on with it’. We’ve heard from many primary care and system leaders who are creating one-system approaches to population health, access, reducing health inequalities driven by integrated working across organisations. Given many of the report’s recommendations were for ICSs this shows how, when given agency and autonomy, they can make efficient progress, balancing national level recommendations and vision with local knowledge and awareness.
But primary care faces barriers to delivery and there needs to be some level of realism and honesty around how quickly progress can be made with the current levels of demand, workforce pressures (including staff burnout) and uncertainty that exists as work on future contracts begins.
When Claire Fuller spoke at our primary care conference in February, she noted that one of the biggest issues she was seeing right now was the division between secondary care and primary care. This is causing many of the problems for patients today at a local level – the lack of data sharing, the failure demand, the poor patient pathways.
We know that another big issue for patients is simply getting through to their GP practice on the phone – an issue which members are working hard to address with the resources available. But there is only so much difference this will make without tackling wider issues, most notably workforce shortages and primary care services plagued by crumbling estates and infrastructure; something which requires capital investment and support at both national and system level. The forthcoming Delivery Plan for Recovering Access to Primary Care must look to acknowledge and address this.
There are also wider cultural issues that need to be addressed around primary care. We need to see greater recognition that primary care is not just about general practice but about all services that people can access without a referral, and a better understanding that it is about multi-disciplinary team working rather than just general practice trying to do everything on its own.
At NHS Confederation, we have built a programme of work designed to bring together local primary care leaders in their implementation of the Fuller stocktake with specific groups around key areas of the report: Data & Digital; Workforce & Estates; Commissioning & Contracting; Access and Integrated Neighbourhood teams. We believe that given the report was informed by those ‘doing the doing’, the implementation also needs to involve those people and organisations.
Despite everything right now there is still energy and amazing, innovative things happening all the time within primary care. There are still solution-focused, passionate leaders wanting to make things better for their local populations and getting on with it. We are proud to be able to host spaces for these people to connect with and support one another to deliver the vision set out in the report for integration, collaboration, personalised care and prevention.
The recent Hewitt Review not only welcomed the Fuller Stocktake but recognised many of the same issues and opportunities around primary care voice (not just general practice), general practice sustainability and the issues with current funding arrangements. While implementation of the Fuller recommendations has been slower than anticipated, Hewitt should give it further impetus; its vision can come to life across the country driven by primary care and enabled by system and national leadership.
Ruth Rankine is director of the primary care network at the NHS Confederation.