Scaling up with new hope

Dr Pramit Patel finds cause for optimism in an increased commitment to primary care through new funding streams and a review of how best to support the sector within ICSs

This winter looks set to be like no other. The NHS is already under incredible strain. We have experienced winter pressures in the summer, we are still – despite what some people would like to think – in a pandemic while continuing to vaccinate people against Covid-19 and, latterly, flu. We are also trying to recover from the pandemic, to make headway against backlogs. Fortunately, more patients feel secure in coming forward but this is exacerbating access issues. Indeed, a recent NHS Confederation poll shows 88% of healthcare professionals say their job is ‘unsustainable’.

Although this paints a sorrowful picture, there is cause for optimism in the shape of increased commitments to support primary care. In the recent spending review, the Government confirmed the NHS in England will receive £30.3bn to 2024/25 in recognition of the struggles we are facing. Both the Elective Recovery Fund and the Winter Access Fund are new funding streams. And NHS chief executive Amanda Pritchard has commissioned a review of how integrated primary care can be achieved and supported in ICSs.

To me, this looks like an acknowledgement of where the barriers to integration lie as well as the beginnings of an action plan, with the wider primary care system as the beneficiary.

It is also recognition of the power of primary care at scale, working collaboratively and with other partners. As PCNs, in many cases working with GP federations, we delivered a life-saving vaccination programme. As multi-professional clinical teams, we stepped in to staff Covid wards alongside our hospital colleagues. This is the mentality we need this winter. As a GP practice and as a PCN we are preparing by piloting a project with the discharge team at our local acute hospital, interfacing with our anticipatory care hubs, and I know of colleagues who are doing similar.

However, we cannot do this alone. We need the Government to defend us as a profession and take every step, alongside NHS England and NHS Improvement, to condemn abuse of primary care staff. We also need a Government that communicates honestly with the public about access. This includes clear central communications to help people understand the best way to access care, consulting us on announcements before they are released to the press, and candidness about the seriousness of rising Covid-19 cases and the protection that vaccinations provide. ICSs and commissioners could also do more to enable primary care, including fostering dialogue, relieving some of the administrative burdens and treating us as equal partners in the system. 

It will certainly be a tough winter, but I know primary care will always put patients first. Covid is here to stay so we must find a way to recover and reform. It is only through working together at scale and with our partners that we can meet these challenges. The clear support for integrated primary care is testament to the good work of PCNs, providing enhanced services in the community and growing our depleted workforce. This, coupled with the transition to statutory ICSs, is an opportunity for primary care to transform how services are delivered, advocating for our patients. By working together, primary care can transform service delivery from the ground up.

Dr Pramit Patel is chair of the NHS Confederation’s PCN network and GP clinical director for Care Collaborative PCN, Surrey Heartlands