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Top down or bottom up? A question we ask time again in the health service, especially since the implementation of the Health and Social Care Act which was designed to give more influence to local clinicians in the commissioning process. However, whilst the structures have changed, the tensions still seem to persist between old and new, national frameworks versus local autonomy and cynicism about change versus the desire to innovate and improve.
In August last year, NHS England launched the Call to Action for General Practice. We know general practice wants and needs to transform the way it provides services to address the challenges and develop a modern and sustainable primary care system. The call to action aimed to help stimulate debate amongst GP practices, area teams, CCGs, health and wellbeing boards and other community partners as to how best to develop general practice services fit for the future.
Last week, NHS England published the emerging findings from the Call to Action which focuses on the central role NHS England wants general practice to play in wider systems of primary care.
It describes the ambition for greater collaboration with CCGs in the commissioning of general practice and sets out how transformational change should be led locally, according to the priorities and needs of local populations.
The document also offers independent analysis of the 521 responses to the consultation, which provided valuable feedback both in terms of the issues, as well as the Call to Action process itself. The feedback is now being used to inform ongoing engagement with patient groups, primary care partners and other stakeholders.
The independent analysis also brought out a number of issues that respondents were particularly keen to explore, ranging from the need for IT systems to be aligned across primary and secondary care, to the pooling of resources to better enable integrated working.
Feedback makes clear that to adequately work with patients with long term conditions (LTCs) and complex needs – including those with learning disabilities – we need to provide more proactive, coordinated care and support and there needs to be a more flexible approach to consultation length.
At the weekend, Dr Maureen Baker said GP services are ‘under severe threat of extinction’. I agree with Dr Baker that GPs are under pressure and demand for general practice continues to rise and that is why we needed this call to action.
Things have to change if we are to provide the primary care services patients expect and deserve. Ways of working must change if we are to develop a specialty that appeals to new graduates. Some of this needs to be done centrally, through designing training and revalidation processes, but much of that which will have the biggest impact will happen at a local level.
Indeed, general practice colleagues and clinical commissioning groups are already looking at how they can transform the way they provide services for the benefit of patients. The questions in the call to action are designed to support existing examples of local action and to stimulate similar approaches across the whole country.
So, let’s look at what local models of delivery exist or are being developed across the country. Can the best practice be shared and the models replicated? Or do they just work well because of specific local patient needs, relationships or particular circumstances in a local community? What works for the local communities in Cumbria, will not necessarily be best for Cambridge. There is widespread agreement that in supporting reform of primary care services, NHS England must build on the many strengths of general practice such as its system of registered patient lists, its generalist skills and its central role in the management of long term conditions.
The final strategic framework for commissioning primary care will be published in the autumn, taking into account the outcome of similar engagements for NHS dental, community pharmacy and eye health services. As we move towards this goal, I hope that the idea, contributions and debate continue.