PCNs and the Hewitt Review

Columnist Professor Aruna Garcea says the recent Hewitt Review should be supported wholeheartedly

Primary care at scale offers a blueprint for providing support and services in different levels of core general practice, to mitigate pressures and preserve continuity and personalised care.

The Hewitt Review report offers a step in the right direction to address the challenges faced by primary care. At first glance, its suggestion of a contract review may seem worrying. However, we should remember that national negotiations for the next GP and PCN contracts are due this year. The Hewitt Review has supported the preservation of successful GP partnerships and has also asked for a review of local contracting with primary care. This review will allow for a more facilitative approach to support primary care to innovate and integrate, to incentivise outcomes rather than activity, and clarify financial support for integrated pathways that shift care into the community. These recommendations will allow primary care to enable different local models to deliver care.

The report recommends establishing a national partnership group to develop a framework for general practice contracts, with a focus on diversity. The report also suggests that any contract review should consider how systems can help partners who wish to operate at scale while encouraging and incentivising others to move this way.

For a long time, primary care has recognised that demand management is unsustainable and is making health inequalities worse. There is a critical need to move to prevention and health creation upstream. The Hewitt Review has clearly acknowledged the importance of primary care, PCNs and community partnerships in delivering population health management and addressing health inequalities. The review reinforces the commitment to the principle of subsidiarity and the role of place-based partnerships and bottom-up and integrated approach to care. 

The need to enhance primary care is more pressing than ever, and the opportunities are plentiful. Providers and leaders across the country are recognising the urgency of organising and collaborating to establish primary care collaboratives in integrated care systems (ICSs). These collaboratives serve as a crucial platform for leaders to come together and tackle challenges at a wider system level. Moreover, they enable primary care to have a voice in the system while facilitating further integration and collaboration. Although primary care provider collaboratives are relatively new, they have already demonstrated success in mental health and secondary care for several years and are acknowledged in the review as key partners.

Funding for provider collaboratives via ring-fenced budgets would enable primary care professionals to dedicate time to building and running them. For the collaboratives to succeed across the country, this funding is vital.

The Hewitt Review offers an opportunity for primary care providers to embrace new approaches to navigate challenges and capitalise on opportunities. The Government must endorse and accept all the recommendations, so the health and care system can meet the challenges and opportunities ahead, and most importantly, act on them.

Professor Aruna Garcea is clinical director for Leicester City and Universities PCN and chair of the NHS Confederation’s PCN advisory group