Taking a strategic approach to primary care
The challenges for primary care are immense at the current time and with financial pressures affecting commissioners and providers alike it’s important that integrated care boards (ICBs) have a strong primary care strategy to guide future decision making. The strategy should include all four primary care contractor groups. It should look at the wider links, such as supporting reductions in demand for A&E and enabling hospital discharges.
The strategy needs to be able to support ICB decision making. For example, will it help the ICB make decisions on the commissioning of additional primary care dental services from any underspends – to ensure that they link to population health improvements and have proven effectiveness.
It’s vital that the strategy considers the future footprint of primary care, considering what the ICB may do to secure primary medical care services should a practice hand back its contract. Would, for example, the ICB wish to work with a PCN to secure services in the first instance, being mindful of the contractual forms that they can use to secure primary medical care services and considering the new provider selection regime.
It’s a difficult time for community pharmacy. Although Pharmacy First has gone live, which allows pharmacists to develop their roles, the number of pharmacy closures, and reductions in opening hours, will impact on the ICB’s strategic plan for primary care. To seek to address these issues it may be necessary to discuss bringing forward the pharmaceutical needs assessment refresh, for which the local authority’s health and wellbeing board has responsibility. There are obvious links to the primary care strategy.
There is also a requirement for ICBs to draft their infrastructure strategy, the primary care strategy is integral to this taking into account the PCNs’ clinical and premises strategies.
Although the strategy needs to be inclusive of all areas, those that are involved in shaping the strategy may vary for different clinical pathways. As an example, to consider access to primary medical care ICBs may wish to work with, and identify ways to support, PCNs to help practices meet demand and remain resilient.
Across an ICB there may be different approaches by different PCNs – which should consider the capacity of the practices, local ways of working, and the health needs of the population. ICBs need to work with the PCNs to understand each other’s vision and plans.
A few of the areas that may present opportunities include:
• Pharmacy First understanding of the skills and capacity of pharmacies is a must for practices in a PCN as is skilling practices’ care navigation teams to signpost to community pharmacy accordingly
• Streaming urgent/on the day care into a shared resource
• Sharing back office support
• Use of the additional roles reimbursement scheme staff (and ensuring appropriate signposting by the care navigation team)
Other areas that may impact access need consideration such as:
• Possible practice closures or mergers
• Pharmacy closures
• Workforce and premises constraints
It is essential for primary care commissioners and PCN or primary care provider representatives to have open, honest conversations to agree a shared vision and how to work towards it, in line with the primary care strategy. The strategy should then guide investment decisions, premises considerations and how ICBs may manage any practice closures.
It is not just primary medical care access where this engagement needs to happen – but across multiple pathways. The recent publication of the dental recovery plan Faster, simpler and fairer: our plan to recover and reform NHS dentistry, sets another key priority area as an example.
ICBs have a lot on their plate, but getting a primary care strategy that will help guide future decision making and has buy in from providers is an essential building block.
PCC can provide facilitation of meetings to develop a shared strategic vision, support to draft strategies, technical support around how to realise the vision within the constraints of the primary care contracts, and training of reception or care navigation teams to mention a few areas. Contact enquiries@pcc-cic.org.uk if you would like to discuss how we can help or visit www.pcc-cic.org.uk.