Dr Claire Fuller has today published her report recommending next steps for integrated primary care.
As a group of charities representing millions of people who rely on the services and support provided by GPs and across primary and community care to live well day to day, we really welcome the vision set out today. Ensuring people have access to rapid care whenever they require it, while expanding the depth and breadth of support for people living with more complex needs is the right ambition. Building single, integrated teams bringing professionals and services together and into their communities is the right way to achieve it.
So there is a lot to like in the report
Collective evidence from Richmond Group charity members strongly supports the proposition that demand is rising fast, faster than we might have reasonably expected back in 2019. The impact of the last two years has been profound. There are more people living with health conditions, more people presenting with advanced or severe symptoms, and those already living with conditions have seen their health deteriorate or escalate into multimorbidity. As always, the burden is falling hardest on those in the least advantaged circumstances. So the emphasis on the essential role of primary care and the potential of integrated neighbourhood teams in reducing the burden of ill health and tackling health inequities is to be warmly welcomed. As are recommendations to distribute resources more equitably according to need and address the inverse care law.
The report also sets out a credible response to the challenges of supporting people with more complex needs, who most benefit from the type of relationship-based continuity care that overwhelming strain and stretch across general practice has put at risk. As our own work through The Taskforce on Multiple Conditions has shown, the rise in multiple conditions is the fastest growing challenge for primary and community care services (where most of this need washes up). 1 in 4 of us now live with two or more long term conditions (and in the UK this number is expected to rise to 68% in 2035[1]), but the way primary care is structured and funded doesn’t yet match this reality. Making more proactive, personalised care with support from a multidisciplinary team of professionals available to those who need it, therefore, will be a key test of ICS's progress.
Improving access is the other side of the coin. Something that is often seen as a trade-off with continuity. Yet ensuring quick, seamless access to essential care when people need it is, and must remain, a vital part of the role of ‘first point of contact’ services – typically, but not always or necessarily, GP practices. It would also be wrong to assume patients living with long term conditions prioritise one or the other in binary ways – it depends. Some days quick access will be more important, especially if someone is worried about a new or alarming symptom. Other days people may feel it’s more important to wait and speak to someone who knows and understands them best. So steps to streamline services and maximise the contribution of the wider health team has got to be part of the overall solution.
Turning vision to action
But as the author herself acknowledges, this report lands in a highly challenging context: significant backlogs of care; major workforce challenges; rapidly rising demand and a tight financial settlement. It also represents quite a significant departure from the status quo which will, inevitably, pose a challenge to many of our existing ways of working and, probably more importantly, ways of thinking. So we think it’s fair to say that while achieving consensus over the vision and ambition is no mean feat, moving from vision to action and on to delivery is going to be a difficult trick to pull off. It’s going to take major investment of time and money as well as real, sustained commitment from both national and local partners. Government and national bodies will need to act fast to address the very real underlying challenges the report articulates – workforce, data and the state of the estate – as well as ensure they line up the legislative, contractual and funding frameworks. Local system leaders and professionals will need the time, space and support to develop trusting relationships and translate the national blueprint for their local footprint.
There is huge untapped opportunities to involve the VCSE in this challenge. We are particularly skilled at working at the nexus between clinical and social need and can bring a wealth of insight and experience of working with our populations. We will have a key role to play in building strong neighbourhood teams and must do our part.
No time to lose
As charities, we collectively hear from millions of people about their experiences and spend a lot of time listening to our clinical colleagues. It is clear that primary care is sitting on a powder keg. Public and patient frustration is at a high-water mark perhaps last seen in the 1990s. Professional morale is at the lowest point anyone can recall. Clearly expecting the existing GP workforce to work ever harder or leaving patients without the care they need is not and cannot be the ‘solution’. The Fuller Review offers us a path to a more sustainable future if we are all – professionals, policy makers and patient organisations alike – prepared to be pragmatic, creative and, most critically, willing to embrace the change.
We need to act now though, before that powder keg blows.
[1] NIHR Evidence - Multi-morbidity predicted to increase in the UK over the next 20 years - Informative and accessible health and care research