Primary care is the first port of call for most people when they need medical advice and support, and traditionally the gateway to wider health and care services. Yet it faces significant challenges due to increased caseloads, more patients with complex, long-term needs, and difficulties recruiting and retaining enough staff.

As both the Fuller Report and the Primary Care Access Recovery Plan make clear, collaborating at scale and establishing new ways of working can improve access for people so that they get the help that they need. These projects need to be resourced and this has been recognised in funding decisions. As well as the planned £385 million increase in the Additional Roles Reimbursement Scheme (ARRS), the recovery plan announced extra money and practical support for practices to implement changes.

PCNs across the region are using their resources to work differently. The NHS England South East Primary Care Transformation Programme works with PCNs to support them in the journey to encourage collaboration, champion innovative practice and support the transformation required to deliver sustainable access models for the future. We want to support those who are pushing the boundaries so that we can share learning across the region.

Firstly, the model incorporates several ‘first of type’ innovations that helped it overcome the practical difficulties involved in mobilising ARRS resource. This solution has allowed it to establish a federated way of managing online consultations and enabled the delivery of a wide range of enhanced services by a central hub team, who can now operate seamlessly across practice boundaries using a single log in.

Secondly, the project has demonstrated how the right clinical IT infrastructure, combined with an ongoing commitment to support the workforce through change, can help PCNs answer many of the challenges involved in delivering primary care, cutting bureaucracy, securing efficiencies, increasing appointment capacity, and developing federated systems so that people have consistent, equitable access to the right care at the right time.

And thirdly, one of the most compelling features of this project is that it continues to evolve in a truly sustainable way. The hub has already helped the PCN develop a responsive, data-driven approach to the digital front door of primary care, and it is now opening up opportunities to collaborate more effectively at neighbourhood scale – as happened recently when its hub-based teams stepped up to support neighbouring PCNs in the delivery of spirometry services.

We have worked closely with the PCN senior team over the last year to support the project’s success and ensure that the practical insights falling out of this process can now help others in overcoming the barriers encountered during delivery. While this model approach relates to the EMIS clinical system, many of the third-party supplier functionality will be the same no matter what clinical system you have in place. As a region, we will continue working with other clinical system suppliers and PCNs to nurture and support similar at-scale delivery model approaches.

So, while we recognise that every project will be different with its own distinct challenges, we hope these resources – written, as they are, by those who have been through the experience and reflected generously on the many lessons learnt along the way – will support many others as they embark on their own transformation journey.

James Hempsted-Kingham   

Programme Director – Primary Care Transformation & Digital First

Primary Care Transformation Programme – NHS England South East Region

Tim Caroe

Medical Director, Primary Care Transformation

Primary Care Transformation Programme – NHS England & Improvement South East Region