Case study summary
This case study explores how explores how Primary Care contributes to Integrated Care Systems (ICSs). It looks at the benefits of working in Primary Care Networks to provide more joined-up care for patients and to reduce pressures on the General Practice workforce. The case study shares the approach that GPs in Wave One ICS Dorset are taking to help General Practice in the county to become more resilient and sustainable.
The county of Dorset has an East/West and urban/rural geographical split. It is one of the first wave emergent Integrated Care Systems (ICSs) selected by NHS England on the basis of the maturity of their Sustainability and Transformation Plan (STP) for health and care for their 800,000 people.
In common with many areas in the country, Dorset has a number of challenges around workforce, finances, sustainability of services, quality and access and has established clear plans to transform care in the acute, community and primary care setting including an integrated approach to care across providers.
Primary care has been under considerable strain with a real difficulty in recruitment to GP posts; problems with retention of both young GPs and those nearing the end of their working lives and with a swathe of experienced GPs leaving the profession in their 50s. Workload is cited as a common theme for GPs unwilling to take on or continue with the untenable pressures facing the profession every day.
In an effort to create a resilient and sustainable General Practice as a strong foundation of the system, Dorset GPs have been working together over the last 18 months in 12 locality groups focussing on transformation within their localities. Progressing the High Impact Changes as described in the Five Year Forward View, embedding new care models for frailty, long term conditions such as diabetes, developing plans on estates and technology and delivering improved access to general practice have been part of the daily work for the transformation teams.
Working with the National Association of Primary Care since late 2017, these localities are working on a Primary Care Home approach to develop further “right size” primary care networks for their populations, bringing in the key themes of integration of services, population health management, care focussed on the needs of their local populations, with the potential for shared assets and workforce.
Only by working on all of these issues in this very complex healthcare landscape will the fundamental issues of funding and workload start to be addressed. Clinical leadership with support by creating “headspace” for GPs, practice managers and nursing staff has been crucial to success, as has been an “organic” bottom-up approach which has been led by the localities themselves.
See more on the work which has been underway in Dorset by watching the following video:
Dorset is one of 14 Integrated Care Systems in England, between them serving over 12 million people. ICSs are the result of local health organisations, local government and others joining forces to build local health and care around the patient. Integrated services allow people to be supported and stay well, and mean that when care is needed it is delivered in the right place at the right time. Through integrating services in this way, care for the patient becomes proactive, joined up and tailored to individuals’ needs.
Primary Care is central to every ICS, but rising demand for services has led to substantial pressure on staff. A different model of general practice is needed to help clinicians and other staff to have appropriate workloads and patients to get the best possible care.
CCGs around the country are encouraging all GP practices to become part of a local Primary Care Network (PCN). PCNs are based around a GP registered list of approximately 30,000 – 50,000 patients, encompassing general practice and other partners in community and social care. These networks offer care on a scale which is small enough for patients to get the continuous and personalised care they value, but large enough – in their partnership with others in the local health and care system – to be resilient.
NHS England and NHS Improvement have so far announced two waves of ICSs, each with Primary Care Networks at their centre. NHS England is working with each area to help spread learning and support the development of PCNs nationally.