I don’t know how many local government colleagues have had the chance to read our Secretary of State’s recent speech on a new deal for general practice. The speech reaffirmed the high regard in which we and, more importantly, the public, hold general practice.
The proposed new deal involves a step change in the range and quality of services general practice can offer and builds on the themes and goals of the NHS Five Year Forward View. The starting point is the expansion of the GP and wider primary care workforce, combined with investment in infrastructure, greater scope to innovate and a reduction in bureaucracy to create more time for patient care. At heart it is about freeing up GPs to care proactively for their patients, particularly those who are most vulnerable and frail. In return, we need GPs to step forward to work with other local services more closely and to improve access to their own services.
What I have been reflecting on is the challenge to local government arising from this new deal. A question to every local authority is how close a relationship do you have with your GPs as GPs, not just as commissioners within the CCG? To what extent are local authorities working with local providers to organise their services to support general practice so they can genuinely co-ordinate care for their patients?
We can see plenty of evidence now across the country of primary care expanding its remit, driven by the broader integration agenda, as hospitals, GPs and other local health and care services explore ways to work more closely together. In many areas we are seeing the emergence of ‘primary care clusters’, where GP surgeries and local pharmacies combine their resources and expertise to offer a wider range of services, as well as more weekend and evening appointments.
Elsewhere, larger group practices, already emboldened through the move to co-commissioning of primary care by CCGs, the Prime Minister’s Challenge Fund and the £1billion Primary Care Infrastructure Fund, are being encouraged to employ more senior nurses, geriatricians, social workers, psychiatrists and other specialist clinical professionals. These multispeciality community providers can match their offering to the needs of the local population. This seems to me the most exciting opportunity yet to reduce outpatient and A&E pressures, freeing up hospitals to devote more time and resource to crisis care and other serious clinical conditions.
Local authorities’ response to the changing shape and role of primary care will inevitably affect the way that social care services are commissioned. Local authorities will need to consider the role of primary care in the way that services are provided both for people at home and people in care homes, for example, in the provision of medical reviews, rehabilitation services or early intervention. Social workers and other community based professionals have a vital role to play in this regard (and not just for the elderly), as Lyn Romeo, our Chief Social Worker for Adults, expands on in her most recent blog.
This step change in the coordination of care all requires a firm and informed steer from local social care commissioners working with CCGs to actively shape health and care markets – embracing the potential of, but going beyond the pooling of local health and social care budgets. In Greater Manchester it is joint strategic leadership that is driving the change as much as the mechanisms for action, leading for example, to the accelerated roll-out of 7 day access to primary care services.
An Impower survey last year found that 56% of GPs believe their relationship with social care is poor or very poor. That has to change. The quality of general practice in any community will be the key determinant of whether there is successful transformation of out-of-hospital care. We need local authorities to be a critical agent in ensuring that primary and community care services realise their potential and meet the needs of local people.
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Comment by Robin Miller posted on
Great to see this emphasis on better joint working between general practice and adult social care - in the west midlands we have a regional project developing inter-professional development resources which will help to address some of the key barriers related to the lack of understanding regarding respective roles, responsibilities and pressures, and facilitate better team working in integrated primary care settings. For more details please contact Robin Miller, Health Services Management Centre http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/index.aspx