Networks will support switch to more proactive care

by Dr Raj Patel

07 August 2019

The NHS long-term plan sets out an ambitious programme to transform the NHS with a new service model focused more on prevention and support and delivering joined-up care at the right time in the optimal setting. This summer, the HFMA has invited a number of commentators to address some of the key issues, challenges and opportunities in the plan. This week the focus is on the role of primary care networks.

One of the most pressing economic challenges for general practice is undoubtedly that our national health continues to improve, yet we’re using the NHS more. And for many, there are still unfair economic conditions impacting positive outcomes, with the nation’s future wellbeing relying now on incentivising prevention over the treatment of illness. 

Life expectancy may be rising by five hours a day, but the need for public-funded NHS care rises apace thanks to a growing population of people who are living longer. It costs five times more to look after an 80-year-old than a 30-year-old and there will be two million more over 75s in 10 years’ time.

Primary care has a major part to play in meeting this demand. And it faces multiple other challenges as it does so. These include the impact of digital innovation and the changing demands of employees – the ways our people want to work, when and how. We are also seeing changes in patient expectations.

As part of the most comprehensive overhaul of primary care in a generation, we’re redesigning care, stimulating collaboration and giving people the freedom and flexibility to work in new, leaner and more connected ways.

This overhaul saw the launch of new primary care networks in July with over 99.7% of practices coming together to meet the needs of natural populations and draw down funding for over 20,000 new health professionals.

This will see primary care prioritise prevention like never before. However, the financial practicalities undoubtedly present challenges, with many practices feeding back that change has happened quickly when there’s a lot to get in order behind the scenes.

This can be the most simple financial ask. Who is the signatory on a new bank account now that there are a number of senior decision makers, for example? Or it could involve the more complex resource planning around what types of new healthcare professionals are required and who funds their recruitment, training and ongoing professional development.  Avoiding VAT charges remain perplexing for primary care networks.  

The NHS long-term plan gives us an improved funding path averaging 3.4% a year over the next five years, compared with 2% over the past five years. This is investing £4.5bn extra each year by 2023/24 in primary medical and community health services.

This is good news and provides us with a stable base from which to press ahead with change, but the wider picture – the impact of Brexit and a pending government spending review – gives us further food for thought.

We want our people to come on a journey with us to deliver a leaner, more agile culture of innovation and they are our biggest asset. So much of the success of primary care networks relies on the intelligent application of funding to add value as new teams start to work together.

There is much margin for error, which is where keeping conversations open and transparent and sharing best practice will stand us in great stead if we truly want to reduce unwarranted variations in care.

Primary care networks offer a great opportunity for increasing efficiencies in the NHS by offering the right services, at the right time and where people need them most. By bringing practices, community, mental health, social care, pharmacy, hospital and voluntary services much closer together at a grass-roots level, we can ensure we deliver to those most in need and those most able to benefit. 

From reactively providing appointments, we’ll be able to proactively care for patients, using data and smart thinking to anticipate and respond to future need.

Primary care networks will be small enough to provide valuable personal care. But they will be large enough to have impact and economies of scale through better collaboration between practices and others in the local health and social care system.