New territory… a community centric NHS in our sights

New territory… a community centric NHS in our sights

The late GP Julian Tudor Hart said of GPs that “we claimed as our own, territory we were unable or unwilling to occupy”, a charge that applies not only to GPs.

We now have our moment at long last to develop and sustain a community-centric NHS – our territory. Are there enough of us to deliver, or do we prefer to carp from the side lines?

Primary care networks (PCNs) are now government policy and the National Association of Primary Care (NAPC) through its primary care home (PCH) programme exemplifies par excellence what these networks can achieve if formed, developed and sustained in the manner of the more than 230 PCH sites – with many more are emerging where NAPC are working in STPs and ICSs across England.

The PCH concept which I first described 10 years ago was adopted and developed as policy by the NAPC, began as 15 sites as recently as 2015 and has no doubt strongly influenced current national policy as outlined in the NHS Long Term Plan. How has this primary care revolution occurred?

A successful innovation needs a vision that excites, my original description was of a community provider organisation formed or virtual, funded for its population, that is able to ultimately provide an alternative to current NHS hospital centricity. A home not only for general medical practice but for all who work in primary care and community-based services and potentially a home for many currently working in hospitals’.

A vision must be turned into practical benefits for patients and staff alike which inspiringly continues to be achieved. For the growth and sustainability of PCH, appropriate support is essential which systematically NAPC quintessentially delivers.  The NAPC primary care homes are burgeoning and reshaping care which has very much caught the attention of NHS England. Equally and joyously testament from PCH clinicians describe emancipation, fulfilment and self- realisation. Lose that at our peril.

Development of national policy often seems to perpetuate behaviours that frustrate the purpose of the policy. I have a fear that the plan for universal coverage of primary care networks will suffer a similar fate unless primary care clinicians and NHS managers truly own the radical options on offer.

The NAPC approach offers so much but whatever option is chosen certain principles ideally should be maintained. Existing primary care homes and ‘super practices’ seem to succeed as many have strong internal and professionally-led networks.

We must create organisations that are both small and local and big and strategic so the PCN and the practices and other local strong groups of clinicians are equally important.

No rigid hierarchy, a sound governance of which devolution and trusting relationships are key principles – in contrast to the compliance-focused traditional NHS governance approach.

A useful mantra is “We need to have relationships underpinned by contracts, not relationships defined by contracts”.

Underpinning all is of course leadership – a leadership that goes with identifying and working with the enthusiasts, the energetic, the aspirational and the positive.

Misguided arguments for achieving equity by working at the pace of the slowest often stifle the innovators. If innovation is successful it must then of course be spread, as equity is of course fundamental to our NHS.

If new primary care networks become as successful as primary care homes, primary and community care will have claimed with genuine validity their territory.

We have much to do – primary care networks, the new GP contract framework and developments in NHS community and social services are all intertwined and central to our purpose. If we display a narrow interest, we will waste the potential of what can be achieved and a community-centric NHS will continue to be in jeopardy.

David Colin-Thomé

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