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The demand on primary care is immense. It’s a problem that is easy to identify but difficult to fix.
PCNs were created to dissolve the divide between primary and community health services, to manage demand via extra staff from the additional roles reimbursement scheme (ARRS), find proactive ways of caring for whole populations and tackle areas such as care home residents and health inequalities, which create demand both at primary care level and in hospitals.
There are pockets of great work, as highlighted in our latest roundtable. In north-east London, the focus is on pre-diabetes. In Hampshire, it’s homelessness. In Cheshire, the PCN is trialling machines that monitor height, weight, blood pressure and pulse to pick up early warning signs.
But there are a number of problems. First, the benefits of population health management and preventive care can take years to come through. Preventing diabetes 10 years down the line is long-term thinking, which is not compatible with politics. Second, this work will actually increase demand by finding people who aren’t attending the GP who need to. We have to meet that demand. Third, as Dr Claire Fuller, author of Next Step for Integrating Primary Care, points out in Leading Questions, the scale of the demand can’t be planned for. Lastly, the issue is complex as demand does not always equate to need. As Dr Kieran Gilmartin notes in the roundtable, the patients with the highest demand are ‘those who shout loudest’.
The new integrated care boards (ICBs) should tackle some of these issues. Cost-benefit analysis of population health management and preventive healthcare should be worked up to make the case for long-term resources.
ICBs should quantify demand in primary care. Efforts were being made by clinical commissioning groups (CCGs) by adapting the operational pressures escalation levels (OPEL) framework, used in hospitals. This work must spread to give primary care a cohesive idea of the pressures at each level of the system. This would help PCNs support practices and use all staff effectively.
And NHS England must embark on a public information campaign that the GP practice is not just the place you see your GP. There cannot be a public perception that the GP is always the first port of call. And the investment in the ARRS demonstrates NHS England believes this too. So alongside the ads that tell patients to see their GP if they have a cough for more than three weeks, there must also be a campaign about when it might be better to see a care co-ordinator, link worker, mental health practitioner, nurse, physiotherapist, occupational therapist, podiatrist or dietitian.
PCNs must be assured that ARRS funding will not be pulled in two years because of rising inflation, as reported in Pulse. And PCNs must be supported to recruit, train, manage and locate ARRS staff so they can be the standalone professionals outlined in our piece on occupational therapists. And of course, we must ensure the workforce is there to be recruited in the first place. It’s no easy fix.
Read the autumn 2022 issue of Pulse PCN online here.