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Primary Care Review seeks to ‘turn the NHS inside out’ – a C4PC response to the Fuller Stocktake report – Author Kim Ryley

So, at a personal level, there is much to welcome in the recommendations of the recently published Fuller Stocktake report. As Chair of the Coalition also, I’m really pleased with the boldness of its long-advocated vision for more compassionate integrated Primary Care which, like in a stick of rock, has the key principles of Personalised Care visibly running right through it.

It is encouraging that the report is a product of real engagement with service users, and so emphasises that the new Primary Care system it promotes must be based on ‘what matters to me, not what is the matter with me.’ It supports comprehensive and coordinated care around the individual, greater self-care and self-management of health and wellbeing, shared decision-making on co-produced care plans, and the expansion of Personal Health Budgets. These are all things the Coalition continues to advocate strongly for and on which we have a wealth of expertise to share.

The Report’s recommendations have been widely welcomed as a ‘turning point’ or ‘watershed moment’ and they must be implemented quickly (by April 2024). C4PC stands ready to support these changes with our wealth of insights from lived-experience narratives on what works, and our ability to showcase emerging best practice in co-production and self-managed care, as well as our experience in community development initiatives and relationship building.

We are in the active process of refreshing our current Workplan to put a greater emphasis on working with the new Integrated Care Systems, as well as with a growing range of colleagues in NHSE and Social Care. We are also expanding the reach of our extensive professional networks to have more impact in creating a real buzz around Personalised Care practices and supporting innovative approaches at the frontline.

Together, we believe that we can turn the current top-down monolith of the NHS ‘inside out’ so that it is reshaped in partnership within local communities, by those at the frontline who actually make the health and care system work on a daily basis.

Summary of the Report’s Analysis and Recommendations

The Review Report rightly accepts that the current system of Primary Care is fragmented and no longer fit for purpose. It cannot provide joined-up solutions to the health demands caused by growing social and economic inequalities. As a result, there is increased discontent amongst both the public and professionals, with both patient satisfaction and staff morale at an all-time low.

The report admits that the whole system is unsustainable in its current form and needs an ambitious and radical overhaul of both its design and service delivery. This must include a shift from the current over-specialised and costly hospital-centric approach to a de-medicalised one based on a more holistic, personalised offer, delivered locally at neighbourhood level by integrated, co-located multi-disciplinary teams with increased capacity and a philosophy of local partnership. Such a change will locate Primary Care at the heart of our local communities, as part of a wider move to place-based working, and create the foundations for a reformed health and care system.

At the same time, the whole system will be realigned to put new emphasis on prevention and whole population-based health creation to help everyone stay well for longer. Streamlined access to wider professional advice for all, and more flexible support roles, will help tackle health disparities and inequalities as part of a more compassionate and inclusive culture (that will apply also to employment practices in these services). This new shift to a psychosocial model will both reduce demand and build resilience.

These recommendations recognise that pro-active place-based systems which know and understand local needs are better at creating health, and that autonomous frontline workers, free from top-down, central micro-management, are more likely to generate innovative solutions to problems and improve outcomes for local people. Change will be locally ‘owned’ and driven in future, with national policy supporting this rather than suppressing it.

Encouragingly, improving strained relationships between the public and health and care services is seen as key to success, not least in restoring public confidence. Such strong connections and trust are essential if people are to feel empowered to take greater control of their lives and their health. It has been said that the NHS has no ‘language of relationships’ and little framework to improve working in partnership with other agencies locally. Clearly this needs to change.

The Review report locates these planned reforms firmly in the new regional landscape of Integrated Care Systems (ICSs), which are seen as key to delivering its recommendations. They must encourage local Primary Care Networks (PCNs) to get fully behind having shared ownership of generating local solutions that also build social capital by investing in community-led initiatives. Practical steps need to be taken also to take flexible new roles, such as Social Prescribing Link Workers and Health Coaches to the next level of their development as ‘bridge-builders’ in the new local systems.

But success depends on a range of wider issues also being tackled urgently at national level. These include workforce issues, such as low morale and burnout, high vacancies/turnover, growth in capacity, and retraining for new roles and ways of working. Adequate funding is needed for new investments in modernised facilities and digital solutions to support change happening, as well as new commissioning arrangements.