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What now for primary care

 

Blog headlines

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

  • Virtual Consultations– the patient perspective
    2 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article.

  • Virtual Consultations– the patient perspective
    1 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article - Virtual Consultations– the patient perspective.

  • Celebrating innovation in eye research
    24 September 2020

    This week Julian Jackson from VisionBridge has shared a report on eye research.

  • Link of the week: Comprehensive Spending Review and Covid-19
    24 September 2020

    This week we are sharing a blog that outlines the funding pressures and uncertainties faced by the health and care system

  • Risk stratifying elective care patients
    10 September 2020

    This blog has been shared by MBI healthcare technologies. As services are starting to treat routine patients those on waiting lists are making enquiries as to where they are on the list, and if they are still on the list.

  • Link of the week
    4 September 2020

    This week the link we would like to share are reflections from physiotherapy students on placement at Alzheimer Scotland https://letstalkaboutdementia.wordpress.com/

  • Link of the week
    28 August 2020

    This week we would like to share a blog published on the Mind website about being a BAME health worker in the pandemic.

  • Remote clinical triage model
    20 August 2020

    This week we are sharing how a remote clinical triage model was implemented at Tollgate Medical Centre. This has been shared with us by Sarah Portway, a Nurse, and Clinical Services Manager at Tollgate Medical Centre.

  • Can the Community Pharmacy become the gateway to integrated care in the NHS?
    13 August 2020

    The NHS is a continually evolving innovative demand led public service the role of the Community Pharmacist is becoming the public face on a journey to the more responsible public engagement in the personal care of individuals and their family. There are currently over 11000 Pharmacies many are single or small chain service providers, while multiples occupy the urban shopping centres and more densely populated conurbations, the value of the rural High Street can’t be understated.

  • Crunch time for patient involvement
    7 August 2020

    There are new challenges for primary care, which could really do with patient input. Mike Etkind, chair of a PPG and founding member of his PCN’s patient group, recognises the size of the task clinical directors have managed over the last few months but identifies two particular issues where patients have a necessary and valuable contribution, that need to be addressed now – the 2020 vaccination programme and primary care from a distance- total triage, remote consultations, and the use of telemedicine.

  • Link of the week - Visionbridge
    31 July 2020

    The link we are sharing this week was submitted by Julian Jackson, Visionbridge.

  • Links of the week
    23 July 2020

    This week we are sharing two articles with you.

 
 
Wednesday, 4 November 2020

What now for primary care

By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

At a time when Government policy is more primary care focused than at any time in my lengthy career. Will primary care use or lose this opportunity? The key question for primary care is how to retain its current strategic importance in the NHS and ideally beyond?

It is imperative for primary care to create a position of indispensability to NHS transformation even beyond its current importance in order to ensure its ongoing centrality to all facets of the NHS. The focus with acknowledgement to Donald Berwick’s original work should be a specific triple aim for primary care. To level up quality and increase the range and scope of primary and community service provision. - To significantly contribute to reshaping hospital services which acute providers and commissioners have failed to do. – To have a central role in health and wellbeing beyond healthcare by developing a public health for primary care.

How can primary care expand its range and scope of services?
It is now for community professionals to seize the opportunity and offer solutions in the dire Covid-19 situation rather than add to the accumulating misery and despair. My life’s work such as it is, has identified that positivity and hope when all seems hopeless will be welcomed at a senior level and influence will surely follow.

The individual PCN must remain the building block. Integrate care in its widest sense including social services and the voluntary sector. Integration is always best delivered locally where trust and relationships make it the optimal place for tackling complexity, paradox and ‘wicked’ problems. And integration has no value unless individual patients demonstrably benefit, otherwise integration only serves more extensive ‘provider capture’. The next steps should be reshaping hospital care by redesigning pathways so that care is delivered 'closer to home', reducing the system's current dependence on hospital in and out-patients services.

The NHS needs its hospitals but not often as they are. Hospital care is changing both rapidly and radically. Innovations in technology, care delivery and in system working require future hospitals to be very different from those of today. And yet UK hospitals seem so resistant to change, seemingly preserved in aspic as the model is virtually unchanged over decades despite enormous advances in investigation and treatment. Hospitals are also the most underperforming sector according to the Care Quality Commission. Surely a strong case for different thinking and doing in the hospital sector. The ambition is that the integrated care systems although currently non statutory, will facilitate the spread of such developments or other hospital transformational initiatives. Hospitals however large and ‘egocentric’ need to work in multi hospital systems to provide the range, knowledge, expertise and patient responsiveness modern care requires and yet also in a local system with community based services in the geography within which each hospital exists.

There are many aspects of hospital activity – as in all parts of the NHS - which are of low value. The current reality is much of care presently undertaken by hospitals does not need to be delivered in hospital settings. Current outpatient care described by Professor Muir Gray as a ‘relic of nineteenth century medicine' of which 2 of every 3 outpatient appointments are patient follow ups, whilst total hospital outpatient attendances have increased to 94 million over the past ten years at a cost of £8 billion a year. The NHS Long Term Plan highlights the move away from traditional outpatient service provision and redesigning the way necessary outpatient care is delivered. The shift away has already been prompted by the current Covid-19 crisis.

Primary Care does not have to do it all. For primary care to achieve its own triple aim a partnership with commissioners is essential. They need to ensure all providers take a population responsibility; they should be partners yet holding providers singular and networks to account with ideally providers setting their own stretching ambitions and indicators of success. However, the individual PCN must remain the building block or we may get drift to larger population size, more impersonality and alienation with a reversion to a top down culture which has bedevilled the NHS and badly served primary care. Transformation of care has started; it’s now the time for PCNs to play their hand.