Let local leaders lead

The challenges facing primary care are well-documented and the overriding direction of travel has been an expectation to do more with less. Rising demand and costs, coupled with real-time cuts in funding and a workforce in crisis have created a perfect storm. We have made it clear that that insufficient funding risks compromising the sustainability of the sector and stalling progress and innovation, for example through primary care networks (PCNs) and primary care collaboratives.  

Over 90% of NHS activity takes place within primary care while it receives less than 9% of the total NHS budget. The economic case for investing more in primary and community care is clear, with our research showing that for every £1 spent there could be increased economic output (gross value added) of £14. 

We welcomed the contract uplift of 4.8% for general practice announced before Christmas – a big improvement on the 1.9% this year. This is the biggest investment into general practice and PCNs since the end of the five-year contract deal two years ago. It will provide much needed financial support for general practice and PCNs, but we need to see the same commitment for our community pharmacy, optometry, dental and audiology colleagues.  

However, whilst financial investment and achieving stability in the short-term for the sector is crucial, it isn’t the solution for the long-term. We share the government’s ambitions to shift more care out of hospitals and into the community, as well as providing more preventative interventions, but these are not new concepts. Achieving them requires us to work in new ways, to think differently and to change how we interact with our system partners and the communities we serve. Without change, we will perpetuate the status quo. It requires commitment from all parts of the health and care system; a commitment to collaborate.  

As the Darzi report highlighted, general practice is the most efficient sector for managing its finances because of its independence. The same can be said for the breadth of primary care. We need to make use of the strength, flexibility and independence to deliver change. Over the past year we have engaged with members to imagine what the future of primary care might look like, and the enablers required to get us there. Fundamentally, we need to move to a high-trust model that balances national priorities with local flexibility to empower local systems to commission and deliver services according to local need.  

We believe that future commissioning arrangements should consider the best scale of delivery and encourage contracts which take an integrated approach between sectors including primary and community care. As primary care provider collaboratives mature, contracts should allow ICBs to delegate budgets and decision-making to collaboratives to support the shift of care closer to home and coordinated delivery of services across primary care. 

A Primary Care Investment Standard, as seen in mental health, could be considered as one way of enabling a move towards a high-trust model of primary care commissioning and delivery tailored to local needs. Inbuilt balancing mechanisms should ensure that inflation never outstrips investment. 

Our members were pleased to see the government continue to support increased flexibility and autonomy around the additional roles reimbursement scheme (ARRS) scheme, as we recommended in our report last year and have long been calling for. These changes reflected the needs of primary care leaders, including the addition of more nurses to the ARRS and the removal of caps on recruiting to patient care roles. With the financial burden on PCNs reduced and red tape removed, local leaders have a real opportunity to recruit the staff they want (including nurses) and deliver more appointments. We have been in favour of ‘letting local leaders lead’ and ensuring that local services are designed around local need rather than arbitrary targets or caps. 

We look forward to seeing the final GP contract for 2025/26 in the spring and to working with the government to achieve its ambitions for the sector.  

By Professor Aruna Garcea, chair of the NHS Confederation’s Primary Care Network