We have come a long way since the beginning of the NHS and seen multiple changes to the way in which primary care is delivered and how patients access services from their local healthcare team. With the 75th birthday of NHS today, this provides an opportunity to reflect on some of the key milestones and initiatives that are as important today as they have ever been.
Back in the 1960s, whilst GPs were the pillars in the community, particularly outside of cities, providing a cradle to grave service, the quality of general practice was variable. It was often seen as a second-class career for those doctors who did not become specialists. In 1967 after much negotiation between the government and the BMA, the GP Charter was established. The plans included the recognition of general practice as a specialty with post graduate training and funding for the improvement of premises and ancillary staff. Arguably the most important theme of the 1960s was the development of personal care services. At the NAPC we have long advocated for care and support for people to be personalised, with local services tailored to meet their needs. We use local data and intelligence to design integrated care models that meet the health, wellbeing and environmental needs of the local population and communities.
During the late 1980s a new payment system for GPs was introduced to encourage more health promotion and prevention activities. Focusing on creating healthier happier communities by empowering people to look after themselves and providing tailored information, advice, and support to enable people to make the right choices for them is key. The effects of how this work has grown can still be seen today, we know from our work across the 42 integrated care systems, that activated patients see their clinicians less, which frees up time for those patients with more complex needs and can lead to savings across the health and care system.
The introduction of computers into general practice led to the digitisation of patients’ records and technology enabled a huge paradigm shift in the way preventative, investigative and curative medicine was approached. Prescribing also became much safer using software that could warn about interactions and side effects. Advances in technology enable new ways of working to ensure patient care is safe and effective. During the pandemic, the uptake of technology was accelerated and w know the opportunities offered by digital solutions are endless both in terms of productivity and efficiency, enabling clinicians to focus on those people with more complex care needs, and in terms of planetary health allowing people to monitor and manage their long-term condition without the need to travel to their local practice. Whilst the speed of adoption of technology across the NHS was amplified during the pandemic, more can be done to foster innovation using digital technology to get the best value for patients and clinicians.
In the late 1990s the NAPC was constituted to represent the interests of primary care professionals and through its influencing and lobbying in the early years, primary medical services contracts were introduced with the NAPC seen as the ‘go to’ organisation in this space. The turn of the new millennium saw a move towards greater responsibility for shaping and commissioning care to local healthcare professionals with the NAPC influencing Government on the need for clinical leadership in the commissioning process.
NAPC has led the development of population health improvement and integrated working for over two decades. Part of this evolution was the creation of the Primary Care Home (PCH), which informed national primary care trust policy and led to the transformation of integrated primary care across England. We established the framework for more personalised pro-active care and support to be provided locally that is tailored towards people’s needs.
More recently with the recognition of the need for hyper local care aligned around population needs, as outlined in the Fuller stocktake, we are working with a number of health and care systems to facilitate new ways of working to deliver integrated care through neighbourhood teams. We enable transformational change, which is often incremental and non-linear, by working in partnership and collaboration with local teams. Coproduction and collaboration with local people and professionals are at the heart of neighbourhood care, with communication and engagement undertaken in a way that resonates with local people. When communities are empowered and flourish, this improves the overall wellbeing of those living and working in the neighbourhood.
Neighbourhood teams are at different stages of maturity and in some areas the inclusion of larger health providers thinking locally about how to deliver population based care is in itself be transformative. It is important to acknowledge that effective and efficient neighbourhood teams need to invest the time to evolve together, building trust and cohesion resulting in high performing flourishing health and care teams.
As we look towards the next big milestone, it is important to be cognisant that the concept of neighbourhood suggests caring about the environment that your community lives in and how that effects on their wellbeing. Caring about the environment for our future generations and being mindful of how we can reduce the impact of health and care delivery chimes with our values on planetary health. We will continue to advocate for opportunities to foster innovation; with digital technology seen as an enabler of integration, by delivering more accessible, continuous care and a better working environment. We know that investment in developing and empowering health and care teams to lead and pioneer change is transformative, allowing systems to learn by experience and share their insights.
Finally, an unwavering commitment to understand population and workforce needs continues to be golden thread needed to ensure care and support available is personalised, meeting the identified health, wellbeing and environmental needs of the population informed by local data, professional insight and the voice of people with lived experience. This results in population health improvements across multiple levels in the health and care system from individuals, neighbourhoods, at Place and the wider integrated care systems. We believe this is the only way to improve the health and wellbeing of people, communities and the workforce that serves them.
