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Scaling up with new hope

Dr Pramit Patel finds cause for optimism in an increased commitment to primary care through new funding streams and a review of how best to support the sector within ICSs

This winter looks set to be like no other. The NHS is already under incredible strain. We have experienced winter pressures in the summer, we are still – despite what some people would like to think – in a pandemic while continuing to vaccinate people against Covid-19 and, latterly, flu. We are also trying to recover from the pandemic, to make headway against backlogs. Fortunately, more patients feel secure in coming forward but this is exacerbating access issues. Indeed, a recent NHS Confederation poll shows 88% of healthcare professionals say their job is ‘unsustainable’.

Although this paints a sorrowful picture, there is cause for optimism in the shape of increased commitments to support primary care. In the recent spending review, the Government confirmed the NHS in England will receive £30.3bn to 2024/25 in recognition of the struggles we are facing. Both the Elective Recovery Fund and the Winter Access Fund are new funding streams. And NHS chief executive Amanda Pritchard has commissioned a review of how integrated primary care can be achieved and supported in ICSs.

To me, this looks like an acknowledgement of where the barriers to integration lie as well as the beginnings of an action plan, with the wider primary care system as the beneficiary.

It is also recognition of the power of primary care at scale, working collaboratively and with other partners. As PCNs, in many cases working with GP federations, we delivered a life-saving vaccination programme. As multi-professional clinical teams, we stepped in to staff Covid wards alongside our hospital colleagues. This is the mentality we need this winter. As a GP practice and as a PCN we are preparing by piloting a project with the discharge team at our local acute hospital, interfacing with our anticipatory care hubs, and I know of colleagues who are doing similar.

However, we cannot do this alone. We need the Government to defend us as a profession and take every step, alongside NHS England and NHS Improvement, to condemn abuse of primary care staff. We also need a Government that communicates honestly with the public about access. This includes clear central communications to help people understand the best way to access care, consulting us on announcements before they are released to the press, and candidness about the seriousness of rising Covid-19 cases and the protection that vaccinations provide. ICSs and commissioners could also do more to enable primary care, including fostering dialogue, relieving some of the administrative burdens and treating us as equal partners in the system. 

It will certainly be a tough winter, but I know primary care will always put patients first. Covid is here to stay so we must find a way to recover and reform. It is only through working together at scale and with our partners that we can meet these challenges. The clear support for integrated primary care is testament to the good work of PCNs, providing enhanced services in the community and growing our depleted workforce. This, coupled with the transition to statutory ICSs, is an opportunity for primary care to transform how services are delivered, advocating for our patients. By working together, primary care can transform service delivery from the ground up.

Dr Pramit Patel is chair of the NHS Confederation’s PCN network and GP clinical director for Care Collaborative PCN, Surrey Heartlands


q b 27 January, 2022 7:24 pm

Not sure I agree with you.
This is the precursor to a salaried only system, a few at the top will make a shedload whilst chucking the rest of us under the bus.

And why should primary care put patients first?
I think its high time we put our own mental and physical health first.

Paul Attwood 27 January, 2022 8:47 pm

Just when your day couldn’t get worse as a GP along comes this charmer, a beacon of light and hope…….not.

I recognise the type. Spouting bollox of progress, hope, improvement, transformation and optimism to quote just a few of the words used to encourage positivism.

He’s a politico. Chairman of this and Clinical Director of that and to questions will state he “does” GP because he does a few sessions in Greystone Practice. More comfortable in “meetings” and aspiring at some point to supplant Nikita Kanani (MBE) when she decides she no longer wants to keep telling GPs how to do their job.

And I agree with qb, patients come after yourself and your family. Look after number one. Seriously the patients won’t thank you if you die on the altar of the NHS.

Shaba Nabi 28 January, 2022 6:50 am

It seems to me that this integration and shared working is a one way street.

You recount heroic tales of vaccination and helping out in covid wards. But what help are we getting to manage the mental health tsunami or the patients with chronic pain and substance dependence.

To the system, integration means GPs managing the hospital dump – there is no saviour for us.

Put your sanity and your health first and don’t fall for this martyrdom

Dr N 28 January, 2022 9:55 am

FHSAs were a damp squib.
PCOs were a damp squib
Fundholding was OKish until it was deemed too expensive.
PMS was Okish until it was realised we couldnt be micromanaged enough.
PCTs were a damp squib.
CCGs are a damp squib.

Remember the threats that Virgin and supermarkets were going to take over general practice – another damp squib

I give PCNs another three years before their damp squib demise.

ICS are a push to a cheap uber micromanaged salaried service

Turn out The Lights 28 January, 2022 10:05 am

More of the same BS we have been told over the decades, difference now 2 GPs are leaving the service every day.this will not reverse that trend.It also seems most of the Noctors brought in are not helping much either.A continue death spiral more like.

C Ovid 28 January, 2022 11:54 am

Dr Pramit Patel is chair of the NHS Confederation’s PCN network and GP clinical director for Care Collaborative PCN, Surrey Heartlands

Title says it all. This is either a rallying cry or propaganda. Choose which you prefer.
I’m not playing.
..and I’m not there to staff the Covid wards. Haven’t ever seen secondary care coming in to help when we’re overrun. This reinforces the idea that we have spare capacity and aspire to be the failed Consultants that we are considered to be.

C Ovid 28 January, 2022 11:56 am


Hot Felon 28 January, 2022 4:31 pm

A more tone deaf and inappropriate article I have yet to encounter.

Those that can, do; those that can’t sit on multiple committees, ingratiate themselves and eat lots of biscuits in air conditioned portakabins with whiteboards spouting rubbish.

People like this made me retire early at 57.5 – I have 8 weeks to go.

And Thank the Lord for that.

Cameron Wilson 28 January, 2022 7:30 pm

Deluded doesn’t come close! Us with a contract that all and sundry consider a dumping ground versus the insatiable, inefficient but glamorous secondary care and soon to be abetted by the impoverished but politically embarrassing social care demands. Sorry, the result is a foregone conclusion! Can’t believe anyone working in the real world could think otherwise!

Patrufini Duffy 31 January, 2022 2:31 pm

Follow the crowd. Fall of your cliff. You think you’re all integrated and secure in you’re bubbles – instead you are easy pawns, easily tracked, monitored and silenced. I commend anyone with a spine who opted out of a PCN. Period.

David Turner 2 February, 2022 9:19 am

Sorry to say, I have to agree with the above comments.

There is a certain type of language used by some of those who aspire to a gong which uses the maximum amount of words to express the minimum meaning.
Phrases like:
‘….working collaboratively and with other partners…’ and ‘… transition to statutory ICSs, is an opportunity for primary care to transform how services are delivered…’are pathognomonic of this and make me cringe.

Sorry Pramit, but if you want to earn the respect of your colleagues, stop talking in management gobbledygook , roll your sleeves up and join the rest of us back on the front line doing what we were trained for-treating patients!!!

p.s. just a tip, the length of your job title is inversely related to its importance. That’s why ‘GP’ has only 2 letters.

Patrufini Duffy 2 February, 2022 3:41 pm

“The length of your job title is inversely related to its importance. That’s why ‘GP’ has only 2 letters.”. Brilliant. You know when you register a 22 year old new to the city, who is a “non-executive consultant superintendent accounts executive advisor in marketing” that you better get the sertraline, calprotectin and blood test for b12, iron, coeliac and thyroid ready, just in case. That’s integrated care. One stop “efficient patient-centered responsive holistic accessible care” some would say, equally inverse or perverse.