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The next chapter for primary care

The clinical lead for primary care transformation within the Sustainable Improvement Team at NHS England looks at what is next for general practice:

As we celebrate the 70th birthday of the NHS, the vision laid out in the NHS Five Year Forward View of a renewed focus on populations, wellbeing and primary care has never seemed more relevant.

Nor could it be more pertinent to the work of general practice teams across England.

It’s hugely encouraging to see the practical focus of primary care teams on developing not only their resilience at the heart of everyday care but also on working in new ways to improve access, provide a wider range of care outside hospital and improve the appropriateness of how we use our most treasured resource – our staff.

Collaborating in productive networks of primary care teams, broadening our workforce and partnering more closely with other providers and with communities is at the heart of the movement of change we are seeing across the country.

The Royal College of General Practitioners first described GP Federations over a decade ago as a means to improve care and resilience for practices and GPs. The majority of practices are now part of a local network, and the focus has shifted from early discussions about forming structures to a renewed energy to collaborate together for improvement.

General practice has never stayed still. My father entered general practice at a time when the traditional model prevailed of a GP working from their front room, supported usually by their wife and family. Patients still knocked on the front door, waiting in the hallway and being seen by a GP with relatively few options for managing their condition beyond a prescription pad or referral to hospital.

We’ve already come a very long way from that approach. Yet GPs remain passionate about the need to further evolve in order to deliver more of the potential of proactive person-centred and community-connected care that we value.

The General Practice Forward View was introduced to simultaneously stabilise and transform general practice. Its intention was never simply to prop up our existing ways of working, but to support practices’ ambition to continue innovating for the benefit of our patients and the communities we serve.

The work is not complete, and it’s personally very encouraging to see the strength of commitment right across the NHS to the mission of providing the right resources and support to unleash more of the potential of primary care at the heart of a more joined-up health and care system.

NHS England is placing a stronger emphasis on supporting primary care networks as a foundation for improving care for patients and the population, establishing more resilient ways of working and improving working lives, particularly for GPs. As part of this, the General Practice Development Programme will be working more closely with other work-streams such as the GP Access programme.

To support this, Alex Morton will be taking up the reigns of leading the programme from me. Alex already leads the GP Access programme and will be working with Dominic Hardy, Director of Primary Care Delivery, to bring together a new focus on primary care network development.

For myself, I will be moving to work in the sustainable improvement team in NHS England, who host the team who deliver the Time for Care programme. I’ll be focusing my efforts on spreading our vision for the future of primary care, supporting STPs to create really effective plans for provider development, and coaching local leaders through the journey of establishing movements of change. So I’ll very much be serving the same mission, just in a more hands-on role.

It’ll be something of a homecoming, too, and I’m looking forward to working closely again with improvement and transformation colleagues I’ve known for years.

This is an exciting time for primary care, and we’re seeing opportunities opening up that I, with many others, have been working towards for a long time. There’s still so much to do, to provide policy and practical support, and build the capabilities of teams and leaders in primary care. I’m looking forward to this next chapter in that mission, for the NHS and myself personally.

I’d like to say a heartfelt thank you to my colleagues in the national policy teams at NHS England, alongside whom I’ve worked over the past five years. This is a bunch of some of the cleverest, most committed and hardworking people I’ve met in the NHS. It has been a privilege to serve with them and learn from them.

The NHS at 70 is something to be immensely proud of, and I’m confident primary care will continue to play a stronger role at the heart of it. I’m very privileged to be able to continue to be a part of our continued improvement, albeit in a different role.

Dr Robert Varnam

Dr Robert Varnam PhD MSc MRCGP is the Head of General Practice Development at NHS England and a GP in a large inner city practice in Rusholme, Manchester.

Robert has been involved in leading service improvement and clinical governance within his practice, in the local area and nationally. He previously held roles in the PCT and practice based commissioning group, and was clinical lead for practice accreditation at the Royal College of General Practitioners.

His research work at the University of Manchester covered both epidemiological and sociological approaches to understanding quality and patient safety in primary care. He was involved in introducing new research governance procedures at the National Primary Care Research and Development Centre.

At the NHS Institute for Innovation and Improvement, Robert was involved in the establishment of novel development programmes for primary care staff, to build practices’ ability to improve safety, quality and productivity.

Robert co-chaired the NHS Future Forum’s work on integrated care. He has been involved in the development of clinically led commissioning, including frameworks for authorising and supporting CCGs. He helped to establish the Royal College of GPs’ Centre for Commissioning and the NHS Institute’s development programmes for CCGs, and created NHS Improving Quality’s transformational change programme. He has provided advice on large scale change for policymakers and healthcare leaders from Birmingham to British Columbia.

Robert joined NHS England in 2013, with responsibility for developing policies and programmes to promote, support and sustain innovation and improvement in general practice. His aim is to make it easier for practices to make care more proactive and coordinated, holistic and person-centred, with fast and responsive access, effective health promotion and consistently high quality.

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  1. Awadh Jha says:

    Thanks for giving us a very comprehensive view of the Next Chapter in Primary Care.
    We are beginning to see examples of real change, and whilst we understand that not every practice is seeing the benefit of every part of the GPFV yet, we should all benefit from this. Federation is catching up in our patch. Please keep enthusing us to work in collaboration with other Practices, not necessarily to merge or relocate. Are our Local Care Team is working better.