Flux capacity

Professor Aruna Garcea says primary care must make maximum use of the breadth of its roles to cope with winter 

Primary care has been at the forefront of care delivery through multidisciplinary teams (MDTs). Nowhere is this more evident than in PCNs, which have seen a rapid increase of the MDT with the recruitment of more than 29,000 primary care and additional roles reimbursement scheme (ARRS) posts since 2019; exceeding targets. Two critical papers, both of which have a direct impact on primary care, were recently published: the delivery plan for primary care access recovery and the long-awaited workforce plan. Both of these recognised the success of MDTs in primary care and describe measures to build on that achievement.

While we appreciate the benefits of MDTs with a wider set of skills to deliver a broader range of services, as identified by the PCN DES, PCNs’ capacity to translate the full potential has varied. As we prepare for another challenging winter, how can we ensure we are fully using MDTs to fulfil patient needs while realising the potential for resilience and transformation in primary care?    

We must now understand what more we can do to work as effectively as possible, not least because enhanced access means there are more appointments available at the PCN scale. Care navigation, integration, collaboration and population health management will all be important here.  

To ensure all this is done successfully, integrated care boards (ICBs) and national policy must facilitate the enormous organisation development support that a transformation initiative like this requires, especially when the GP workforce is under significant strain. 

The right infrastructure is also vital, as is capital investment so that primary care estates can house these diverse MDT roles.  

Primary care will also need support from ICBs with their digital implementation projects, as outlined in the recovery plan. This includes support for population health management, ensuring primary care can tailor services to local needs.  

Meanwhile, further additional winter funding needs to be released sooner rather than later. Releasing extra investment to ICBs means they can then fully engage primary care to co-create solutions, instead of scrambling to make ends meet during the colder months. 

Recognising and supporting GPs’ evolution as ‘consultants’ in primary care is a critical acknowledgement of us – as a profession and as key players in the system. It will allow us to deliver effective clinical supervision and dynamic support to our teams, as these demands can place significant pressures on GPs and clinical directors (CDs). Clinical supervision and organisation development are critical issues that help us to maintain clinical quality and demonstrate continuity of patient care across MDTs, while improving capabilities for current and future demands. 

We have fewer full-time GPs than before the pandemic, who are delivering 12% more appointments. It is vital that we make the best use of the breadth of primary care to have the best chance of meeting winter pressures. We must recognise the importance of collaborating with other systems and ensure primary care is supported to deliver for patients in the months ahead. 

Professor Aruna Garcea is clinical director for Leicester City and Universities PCN and chair of
the NHS Confederation’s PCN advisory group. This article was first published in Pulse PCN print Sep 1 2023