The NHS Long Term Plan and its impact on primary care

Another year is underway, a chance to refresh resolutions, to clear heads and to set intentions.

Another year which started with a pressured day in surgery, with one unwell person followed by another, and a long empty coffee cup on my desk. Another year and maybe something different? A Long Term Plan for the NHS.

Now that it has been published, the eagerly awaited NHS Long Term Plan maintains our hope for primary care. It sets out a series of long term aspirations for the health service and fundamentally redefines how we will deliver care to our population.

It is based on work that many NHS healthcare professionals – not least of all GPs – are already part of, and valuable insights they have shared as part of the 2.500 submissions we received from individuals and groups representing the opinions and interests of 3.5 million people.

The plan describes how – for the first time – we will commit to a ringfenced local fund worth at least an extra £4.5billion a year by 2023-4. That’s £1 billion more than we expected prior to Christmas.

It now feels that 2019 really could be the year we have an unprecedented opportunity to work differently.

This is the year we will give more backing to primary care. The plan describes a chance for practices, no matter their size, to work together through primary care networks (PCNs) and to support each other while providing improved services to patients, including weekend and evening appointments.

This is the year we will progress and build on our work tackling workforce issues, recruiting more GPs, retaining GPs and having more GPs in training than ever before. The plan explains how we will expand the workforce with pharmacists, physiotherapists, social prescribers, paramedics and physician assistants, and rebuild and reconnect relationships locally.

For the first time in more than a decade, we can ramp up plans to build a primary healthcare team which respond to the needs of our population and fundamentally tackle the serious workforce recruitment and retention issues we are all experiencing. This is the year we also back community care, recognising the incredible ability of community teams to work within networks and genuinely integrate care locally.

Imagine your 82-year-old patient with heart failure and fluid overload who needs diuresis, regular blood tests, increased support with personal care and falls risk management. She’s lonely. Anxious. She comes back and forth most weeks – sometimes you need to help her medically. Sometimes you are a hand to hold. Sometimes she is genuinely unwell.

As a general practitioner, imagine having a team around you who can share the responsibility of delivering some of those elements with you, releasing some of your time. Some time for you to see someone else or some time to catch up with a colleague. Time, even, to fill that long empty coffee cup.

If you get time to read any aspect of the plan, please read the summary and see the primacy of primary care.

It sets out the key things you can expect to see and hear about over the next few months and years, as local NHS organisations work with their partners to turn the ambitions in the plan into improvements in services in every part of England.

Among those ambitions are:

  • Delivering community-based physical and mental care for 370,000 people with severe mental illness a year by 2023-24
  • Bringing together different professionals to coordinate care better
  • Helping more people to live independently at home for longer
  • Developing more rapid community response teams to prevent unnecessary hospital spells and speed up discharges home
  • Upgrading NHS staff support to people living in care homes.

Know that the pressures colleagues face, both workload and workforce, are recognised. There is also a greater focus on prevention and addressing health inequalities, and offering digital first care where it is appropriate.

The long term plan will make a real difference. The contract negotiations, the partnership review recommendations, the premises review – even the green paper on social care – will help to make it a reality.

This week we have taken a huge step forward in setting out a more collaborative mindset, where local relationships are key. I look forward to working with fellow GPs and other colleagues to make the aspirations a reality in 2019.

Dr Nikki Kanani is a GP in south-east London and is Medical Director of Primary Care for NHS England and NHS Improvement. Prior to joining NHS England she was Chief Clinical Officer of NHS Bexley Clinical Commissioning Group (CCG).

Nikki has held a range of positions within healthcare to support the development of innovative models of care, highly engaged clinical, patient and public leadership and is passionate about supporting primary care, improving service provision and population wellbeing.

She is a member of The King’s Fund General Advisory Council and holds a MSc in health care commissioning. With her sister she co-founded STEMMsisters, a social enterprise supporting young people to study science, technology, engineering, maths and medicine. She has two young children.

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  1. Raj Matharu says:

    Dear Nikki, that is a very excellent review of the NHS Long Term Plan for general practice. However, there was very little detail to develop community pharmacy as a willing provider within the NHS. After all, every day about 1.8 million people visit a pharmacy in England.

    The “82-year-old patient with heart failure and fluid” is probably well know to her local community pharmacy team and in my experience would pop in for a chat when picking up her repeat medicines.

    Community pharmacy is perhaps the most accessible NHS walk in centre that the NHS has where people walk in freely. It just amazes me that the NHS does not have a specific strategy or long term plan to develop community pharmacy to meet some of the challenges addressed in the NHS Long Term Plan.

    NHS England needs to define Primary Care, because I would consider community pharmacy to be part of Primary Care.



  2. Joannah Keller says:

    Dear Dr Kanani

    This is really great news and a big step forward in Primary Care.

    We have been working as First Point Physiotherapists across the South of England with great success since July 2017.

    We see patients with suspected MSK conditions instead of GP’s saving GP time and pressure. We are able to order investigations and manage referrals as needed.

    We have been working alongside Clinical Pharmacists, Associate Physicians, Emergency Care Practitioners and Advanced Nurse Practitioners. This has been great team working and it is great to see Primary Care getting some support for this model.

    With adequate funding and engagement we defiantly see this as a long term workforce solution the pressures facing primary care.