We welcome the acknowledgement of the need for further support and funding across primary care to enable patients to access care and support more efficiently and effectively, as outlined in today’s publication of the ‘Delivery Plan for Recovering Access to Primary Care’ by NHS England.
Empowering patients through greater choice and enabling access to a wider range of services that meet local needs is a key to providing proactive personalised care. The Delivery Plan’s alignment with the vision for more proactive, anticipatory, and preventative care, as outlined in the Fuller Stocktake, is positive. The renewed importance and emphasis on care being delivered by a range of healthcare professionals appropriate to the needs of the local population, through multi-disciplinary, integrated neighbourhood teams is welcomed.
The plans to level up practices to enable digital online access for more patients is essential and we are supportive of seamless data transfer into the practices to streamline patient requests, so they see the right healthcare professional according to their needs. The NAPC digital expert, Dr Pooja Sikka reflected, “We are pleased to see digital technology and practical solutions such as cloud telephony being promoted as part of the primary care recovery plan. However, the transformation in primary care on the backdrop of workforce shortages and rising chronic and complex care needs, should go further. Greater ring-fenced funding and incentives to scale technology in primary care are needed to support patients to self-manage chronic conditions, support clinical decision-making, provide better tools for an integrated workforce, and address the wider determinants of health – crucially going beyond just solving access alone, taking a population approach to implementing digital health solutions and diagnostics.
This technology is increasingly expected by patients and staff alike as it is in other aspects of our lives. The NAPC has been involved in several projects such as the Digital First programme in NWL, which are already at the forefront of supporting primary care resilience and recovery through digital innovation.”
We welcome the plans to offer patients a greater choice on where and how they access care locally, through a greater role planned for community pharmacies. With the wealth of skill and expertise in community pharmacy teams and the opportunities presented by digital integration between general practice and community pharmacies, the adoption of the neighbourhood care approach will increasingly become a reality. The NAPC President and community pharmacist, Prof. Ash Soni offered these thoughts, “Recognising community pharmacies as being at the heart of a community and an essential part of a neighbourhood is an extremely positive step. With a suitable financial investment pharmacy’s, with their pharmacists and support staff, can provide an excellent first point of contact for a large number of people. This will help to relieve some of the significant pressure on other parts of the system and enable them to support the work of GPs and A&E departments. It is great to see the previous rhetoric about the additional value community pharmacies can offer, now moving into valued delivery.”
The commitment for all practices to be offered care navigation training and the incentive to improve quality of care for patients through QOF avoidable appointments module is encouraging. Ensuring patients have timely and accurate information about the care and support services available in their community is essential. Supporting patients by signposting them to right health and care professionals who can help is a key responsibility of the care navigators and we welcome the acknowledgment of this important role within general practice teams. At the NAPC we have facilitated the training of primary care staff to provide personalised local navigation services for some time. Our primary care navigator programme delivers a range of benefits including increases patient wellbeing, reduction in unnecessary appointment and maximises resources already in the system. For more information about the NAPC primary care navigator programme please contact napc@napc.co.uk
We are encouraged by the commitment to continue funding the ARRS roles after 2023/2024 and the greater flexibility within the scheme for the deployment of staff. Greater autonomy at a local level enables practices and networks to deliver better care for their patients, by tailoring services and resources to best meet their needs. At the NAPC we have championed this approach for some time with impressive results, both in terms of patient outcomes and return on investment. This is evidenced by our evaluation of the social prescribing link workers supporting over four thousand patients in Calderdale, West Yorkshire through the Ageing Well initiative. Data was collected over 2 years across three domains: patient activation, patient health and NHS demand. Improvement in outcomes was demonstrated by a 0.6 point drop in the BMI of obese patients, a 19% increase in patient activation, a ‘saving’ of at least 4 GP contacts over 12 months and £350 per patient reduction in annual hospital cost. For more information about the Ageing Well project, please contact napc@napc.co.uk
Workforce capacity remains a challenge across the whole health service, not just primary care. Any steps to alleviate current pressures on the existing general practice workforce is welcomed. We encourage our members to also think about utilizing the opportunities offered by additional roles and streamlining workflows using digital technology. Supporting existing healthcare professionals is also vital, especially in times of increased demands. Workforce wellbeing is a priority for the NAPC and we have been supporting colleagues across the health and care sector for some time through our CARE programme and collaborating with The One Voice Group to improve wellbeing for our members nationally. We welcome the commitment to continue funding the practitioner health service and its availability to all primary care staff. Raising awareness of the support available is key to this and we encourage our members to make use of these resources should the need arise. The NAPC wellbeing lead, Caroline Rollings said, “It is encouraging to see steps within the ‘Delivery Plan for Recovering Access to Primary Care’ focusing on workforce and wellbeing. We look forward to more detail to understand the potential effect on colleagues across primary care at a time when the biggest concern for NHS organisations is the health, wellbeing, and retention of their staff”.
We welcome the recognition of the importance of planning for primary health care and the increase in its prominence within local authority guidance. The NAPC has developed guidance with Community Health Partnerships to support PCNs undertaking estates planning. Obtaining a collective understand of resources (people and buildings) across a community is an enabler to integration and the delivery of the Fuller stocktake because it supports the move to more integrated working with collaborative teams delivering care across a neighbourhood. The strategic focus to develop the right infrastructure across each integrated care system is an important role for integrated care board’s (ICB) but to ensure the best possible chance of success, we encourage ICBs to find the right balance and allow for flexibility in local interpretation at Place and neighbourhood level when implementing. We would also support the acknowledgment of the value digital solutions, both in terms of workflow efficiencies and improved outcomes for patients through self-care, in the ICB strategies. Digital innovations do not always mean less space in terms capacity, but rather a change in the nature of estates required.
In addition, the alignment of pharmacy, dental and optometry commissioning with general practice commissioning for ICB’s is a practical step towards enabling more integrated care to be delivered across a neighbourhood, with a range of services and providers aligned to local needs. Collaborative partnership working between providers promotes integration and provides a better service for patients. The NAPC President, Prof. Ash Soni added, “It is important for ICBs to use these new commissioning responsibilities to integrate the wider primary care family to support local populations and maintain access to the breadth of service providers. This is a great opportunity to reimagine how to integrate services to improve health outcomes and reduce health inequalities.”
For those practices in the greatest need of support, the Herculean efforts needed to implement these changes cannot be underestimated and we welcome the acknowledgement of this. The mix of online and face to face on the ground support is essential to enable transformation. Clinically led communities of practice, data driven change to improve population health and enabling leaders to navigate change locally is at the core of the NAPC.
The NAPC are leading the way in neighbourhood care development by supporting large scale transformation of primary, community and acute care across several health systems in line with the Fuller Stocktake. Katrina Percy, Lead for Neighbourhood Care Development at the NAPC said, “We have the expertise and proven methodology to transform out of hospital provision, designing new models of care in collaboration with local systems and residents that support integrated neighbourhood teams and meet the needs of the local population”.
For more information on the full range of help and support available from the NAPC, please contact napc@napc.co.uk
