Opinion: Primary care must band together

Sheffield is the focus of the latest in our regional correspondent series. Clinical director of Townships 1 PCN and Chair of Sheffield PCN clinical directors, Dr Tom Holdsworth, explains why primary care must unite. You can read the first article in the series here.

The failure of successive governments to focus health care on communities rather than hospitals, despite repeated visions and strategies, is described in The King’s Fund report Making Care Closer To Home A Reality. 

With the RCGP warning that funding for General Practice is now at an eight year low at 8.4%, it is perhaps no surprise that the report suggests that ‘The failure to grow and invest in primary and community health and care services [is] one of the most significant and long-running failures of policy and implementation in the NHS and social care for more than 30 years’.

Perhaps it gives me some reassurance that my experience locally over the last six months has not been unique, though I suspect some areas have managed better and some have fared worse. In August I wrote about the urgency for the system to transform and how it needed to understand that primary care was vital in this work. Locally I have worked to make sure that this is articulated within the primary care strategy and have also continued to work operationally in my PCN to put this approach in to practice. 

In the PCN we have had great success using health coaching through an organisation called Hero of Health to reverse diabetes, reduce loneliness and improve mental health. Unfortunately, these efforts are not understood or prioritised by a system that remains focused on immediate goals of reducing in-year spend, increasing access and reducing waiting lists. Access, waiting lists and living within your means are not inherently bad things to address, but the ‘at all costs’ approach is a problem.

In November NHS England wrote to integrated care boards (ICBs) asking them to set out plans to ‘address the significant financial challenges created by industrial action in 23/24’.  Following this letter South Yorkshire ICB repurposed a significant portion (approximately £1.3m) of primary care system development funding.  Rather than using the funding for Primary Care Transformation as originally intended, it redirected the money to support the wider system deficit. Actions like this make it easy for many in primary care to feel that the system doesn’t understand them and doesn’t feel the need to work with them in collaboration. The perception that primary care was excluded from decisions about the transformation funding risks adding to the distrust rather than fostering a shared approach. 

If it is clear for now that the system has its focus in the wrong direction, then the question for general practice is what can it do in the meantime? Given the way that general practice and wider primary care is made up, it needs to think like a social movement.

At place or region level these are some of the steps I have been thinking about that may be useful to consider: 

Clarity of your purpose The more clarity about what the ask is from a social movement the better.  So, any work to find common ground about the preferred future of general practice and primary care in your local place is time well spent.

Find you allies Put time and effort into finding the allies in the local systems. There are many from all parts of the system who will understand the need for change but feel powerless. We need to call them in to the movement. We spend too much time calling people out and not enough time calling people in.

Manage your anger It is easy to feel anger with the current status quo. This will be particularly felt in GP partnerships where ‘an end of year deficit’ means a reduction of earnings. However, although anger can mobilise, it can also be destructive, and alienate potential allies of the cause. Use it carefully and try not to let it destroy relationships that may be needed.

Build a plan for success Be aware that many social movements don’t survive success. It’s unlikely with the current political climate that there will be significant system change in the short term, but political winds change, executives come and go, while local grass roots teams work for decades.  If the system does manage a shift in focus from the acute sector to community we need to be ready to seize any opportunities effectively when the time arises. 

It is clearly going to be an extremely difficult and turbulent time for primary care over the next few months. Though difficult, I will try my best to take my own advice and mobilise, find allies and use anger wisely.