What is the Future for a Primary Care-Led NHS?

Robert Boyd

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315348643
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Tax planning can lead to considerable efficiencies, but few GPs have been trained as businessmen. This book in "The Business Side of General Practice" series, provides a guide to the regulations, identifies the pitfalls and opportunities and shows how to maximize the income retained by the practice. John Dean is known for his writing on financial management in general practice and has also written "Making Sense of Practice Finance" (Radcliff).

1

Introduction and overview

Tom Butler

This briefing paper is the second of a series that is intended to provide policy makers, commissioners, managers, primary care professionals and user organizations with up-to-date briefing on important issues for primary care development. The aim is to discuss policy issues and their implications at national and local levels and to review published research that may inform future decision making.

Primary care is increasingly centre stage in NHS plans for the future of health care in the UK. The Department of Health has set out plans for the long-term development of the NHS by four key policies: The Health of the Nation, Caring for People, The Patient’s Charter and a primary care-led NHS. The NHS Executive published a framework of future planning that sets out the medium-term priorities for services.¹ These are: a primary care-led NHS; mental health; effectiveness; patient and public empowerment; continuing care and human resources. This was followed by a consultative paper published by the NHS Executive (1996) in a response to a consultative process established by the Secretary of State for Health.² This paper set out a framework for an emerging agenda on primary care which highlighted seven key themes. These were: resources, partnership in care, developing professional knowledge, patient and carer information and involvement, securing the workforce and premises, better organization and local flexibility.

Primary care is not only a key health policy commitment for the NHS but it is also a priority for service planning for the future. However, these ideas are painted with a broad brush and leave many health professionals speculating about the form and content of future services. For those with responsibility for commissioning and purchasing services, as well as those who deliver services to patients, there is a vacuum in understanding what a primary careled NHS means for them and those who rely on their services. A recent DoH publication prepares the way for new legislation without structural reorganization.³

The purpose of this briefing paper is twofold. First, to explore seven aspects of the move towards a primary care-led NHS and second, to contribute to the debate including an assessment of the future role of the National Centre in informing future discussions with research evidence. This collection of papers draws on a range of research perspectives from within the National Primary Care Research and Development Centre to explore and clarify some of the concepts and implications of this major policy initiative by the NHS Executive.

In the first paper Martin Roland and David Wilkin examine the rationale for moving towards a primary care-led NHS and consider the aims of the NHS, the special features of primary care and the future relationship between the two. They argue that while it is likely that an increased focus on primary care will improve care, this is not guaranteed. The slogan of a ‘primary care-led NHS’ needs to be backed by evidence to ensure a beneficial outcome.

Anne Rogers and Jennie Popay consider user involvement in primary care in the second paper in this collection. The paper describes three distinct ways in which users have or could become involved in primary care services. The first two approaches are associated with past or current practices and the third approach is a response to rapid change and innovation in health care. Rogers and Popay argue that for a primary care-led NHS to produce real patient benefits, a change in professional-lay relationships is needed.

The third paper in the collection is by Robert Boyd, who looks at the challenges posed by the move towards a primary care-led NHS from the perspective of a hospital-based paediatrician. He argues that a primary care-led NHS will be judged by four criteria: the effects it produces on accessibility and acceptability of services, quality of care provided and cost-effectiveness. Boyd sounds a warning note against being too self-congratulatory. He argues that as primary care leadership develops, its ability to correct NHS failures must be enhanced and demonstrated.

Bonnie Sibbald considers key issues in the move towards a primary care-led NHS with regard to innovation and experimentation with the disciplinary mix and roles of the general practice teams. In considering the future direction of primary care development, Sibbald highlights the need to develop an evidence base to underpin skill mix change.

Mental health presentations to primary care is well understood in the literature. The paper by Linda Gask argues that we know relatively little about the patients’ views of the mental health services they receive from primary care. She examines the changing role for two groups of patients: those with mild and moderately severe problems and those with severe, complex and enduring mental health problems. Gask argues that primary care has a key role to play in ensuring that historic divisions between professional disciplines, rigid diagnostic decisions or arbitrary age barriers do not serve patients well. By contrast Gask proposes a new view of the service provision with an emphasis on innovation and co-ordination.

Some of the same themes are explored by Caroline Glendinning in her analysis of the changing interface between primary care and social care. She looks at the boundaries between health and social care and argues that changes at these boundaries are likely to present some of the main challenges to primary care over the next decade. Glendinning identifies a number of factors that will shape the relationship between health and social care, including demographic trends, cost containment and the changing balance between public and private responsibilities. Within this policy context she examines the consequences for service users and the implications for primary care overall, including the impact of changing residential services, the growth of the mixed economy of provision, formal and informal health and social care.

The final paper in this collection is by Martin Roland. It argues the case for a research perspective on the changing face of primary health care and the relationship to secondary and social care. Roland sets out the role of the National Primary Care Research and Development Centre as an NHS-funded independent research agency, working to inform the debates and plans on primary care health policy and professional decision making, through the use of evidence rather than rhetoric. The Centre has five main programme areas and is currently conducting 25 research projects related to primary care.

The move towards a primary care-led NHS presents many opportunities for improved services for patients through local innovation and demonstrations of good practice. Equally it runs the risk of being introduced in an atmosphere of rhetoric and hyperbole that reinforces the well-recognized gap between research and practice in health care decision making. The National Primary Care Research and Development Centre has an important role to play to support and drive research and development initiatives in primary care. This collection of papers is a contribution to help health professionals to close the gap between research and practice in order to take a more informed part in the debate on the move towards a primary care-led NHS.

References

1 NHS Executive. (1996) Priorities and Planning Guidance for the NHS: 1997/99. HMSO, London.

2 NHS Executive. (1996) Primary Care: The Future. HMSO, London.

3 Department of Health. (1996) Choice and Opportunities. HMSO, London.

2

Rationale for moving towards a primary care-led NHS

Martin Roland and David Wilkin

Primary care provides first-contact, generalist continuing care to the great majority of health problems presented to the NHS. Since 1948, a key function of primary care has been to act as a gatekeeper to specialist services. Primary care is, in general, located geographically close to patients’ homes. It treats people in the context of their communities, and is potentially more accountable to its local community.

The UK model of primary care is widely admired in other countries, and in many there is a move to increase the primary care orientation of their health care systems (e.g. the United States, and the countries of Eastern Europe).

It is now proposed that the focus of health care in the UK should move further towards primary care - through changing the focus of both provision and purchasing of health care. If primary care is ‘good’, will more of it be ‘better’? In this paper, three questions will be considered in discussing the rationale for moving towards a primary care-led NHS:

1. What are the aims of the health service?
2. What are the special features of primary care?
3. How can the aims of the health service be more closely approached by increasing those features which relate to primary care?

The paper acknowledges the general practice-based team as the foundation of primary care in the UK, but also recognizes the increasing diversity of community-based providers, and also the diversity of potential purchasing arrangements within the NHS.

What Are the Aims of the Health Service?

The NHS should provide care which has the following characteristics:

• equitable access to all population groups acceptable to the po...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• About the Authors
• 1 Introduction and Overview
• 2 Rationale for Moving Towards a Primary Care-Led NHS
• 3 User Involvement in Primary Care
• 4 Challenges to a Primary Care-Led NHS: A Medical Specialist’s View
• 5 Skill Mix and Professional Roles in Primary Care
• 6 Mental Health Perspectives on a Primary Care-Led NHS
• 7 The Changing Interface Between Primary Care and Social Care
• 8 Evidence-Based Policy Development: The Role of the National Primary Care Research and Development Centre
• Index