Breaking Boundaries: A manifesto for primary care
To mark NHS Change Day, NHS Alliance today launches a new manifesto for primary care, Breaking Boundaries, which calls for a fundamental shift in healthcare from acute to primary setting, it calls for the new Commissioning Board to commit to specific measures, and wants to see a paradigm shift in the management of health, wellbeing and all non-urgent care. We would like to thank Hunter Healthcare and Novartis who have supported the development of this project but who have had no input or influence into content.
How we developed this manifesto
This manifesto was developed with the help of NHS Alliance members and friends, including Dr Judith Smith and Dr Rebecca Rosen at the Nuffield Trust and Dr Anna Dixon at the King’s Fund, to whom we are most grateful. We would like to thank Hunter Healthcare and Novartis who have supported the development of this project but who have had no input or influence into content.
We are indebted to all those who provided the articles (details below) that informed our thinking and those who attended and facilitated a workshop to develop these ideas.
The 25 thought-pieces which make up the manifesto, and will be released gradually throughout the year. The full collection of articles are listed below, and some are already available to read.
The future of primary care
The Future of Primary Care: Dr Michael Dixon, Chair, NHS Alliance, outlines why primary care can – and must – become the designer of the new NHS landscape.
Can policy save the NHS?: Michael Sobanja, NHS Alliance Director of Policy, explains why primary care must seize the current policy agenda to deliver value, shared decision making, strong accountability and better outcomes for patients.
What does good look like for patients?: Jeremy Taylor, chief executive of National Voices, explains what patients want and how “person-centred co-ordinated care” can help deliver this. The challenge is to find how the myriad new structures of the English health and care system can now pull together to make it a reality for patients and their families.
Care without boundaries: the future of information: Dr Mark Davies, Medical Director of the Health and Social Care Information Centre, on GPs’ duty not only to make sure patient data is kept safe and used responsibly for individuals, but also made available to support populations. He describes a vision is for a unified and free-flowing data landscape, uninhibited by historical boundaries between different services and settings, with patient involvement at its core.
Tackling clinical variations in primary care: There is evidence of widespread variation in the quality of general practice. The use of primary care data to support improvements in the quality of care delivery is key to tackling variations, say Anna Dixon, Yang Tian and Veenagh Raleigh of The King’s Fund. General practice needs to be supported to understand variations in the quality of care and to identify areas where improvements are needed.
Practical tools for tackling unwarranted clinical variation in practice: Ruth Chambers, GP and Clinical Director of Practice Development and Performance, and Tracy Cox, Practice Development and Performance Manager, NHS Stoke on Trent CCG, outline a practical approach.
What does CQC inspection mean for primary care?: The CQC explains its new inspection regime
The future of general practice
Should clinical commissioners shape primary care?: Shane Gordon, Amit Bhargava and Julie Wood argue that, although CCGs do not commission primary care, they could help shape its future in a changing world if general practice will let them.
A series of papers explore what shape general practice might take to break existing boundaries:
- Caroline Kerby and colleagues explore whether the small general practice, locally known and trusted, should be superseded by super practices based on economies of scale? Or do we need new models that take the best of both worlds?
- Dr Brian Fisher, PPI lead for the NHS Alliance, explores a co-production model for the NHS in which general practice looks outwards to local neighbourhoods to create supportive social networks, seeking out local energy, where it exists, to help deliver and broaden services, and seeing clients for what they can do, not just what they need.
- Professor David Colin-Thomé and Dr Brian Fisher argue for creating a new “primary care home” in which organisations can work together to provide services at scale, but maintain the values that come with being small and local.
- The communities we live in affect our health. Professor Chris Drinkwater and Dr Brian Fisher argue that primary care needs to take a wider approach to building healthier communities that focuses on people not places.
- Dr Minoo Irani and Dr Donal Hynes argue for vertical integration by breaking down the organisational and professional boundaries that have limited the success of delivering integrated care.
Changing the culture of primary care
Changing the culture of primary care: Everyone understands that the culture of primary care matters – but what does good culture/primary care look like? Yvonne Sawbridge, Senior Fellow, Health Services Management Centre, University of Birmingham, kicks off the discussion and argues for a dose of anarchy.
Building our own community: Heather Henry argues that the primary care community is showing the same symptoms of disempowerment as other disadvantaged communities – and could use the same tools to address this.
Housing and primary care: making integration meaningful: Jake Eliot, Policy Lead, National Housing Federation, argues that closer working between primary care and housing associations is vital to delivering high quality, sustainable services.
Sharing successes and learning from failure: Yvonne Sawbridge and Rick Stern argue that leaders in primary care need to focus on developing a culture that prevents failure and learns from past mistakes.
New models for integrating services
Integrating Physical and Mental Health: Professor Chris Drinkwater, public health lead for the NHS Alliance, and Dr Brian Fisher, PPI lead for the NHS Alliance, argue that integrating mental and physical health services, and promoting mental wellbeing makes sense for people, populations and the public purse.
Integration in the new environment – what is the vision and how to we advance it?: Dr Donal Hynes, NHS Alliance co vice chair, and Dr Minoo Irani, NHS Alliance specialist networks lead, argue for an integrated system that sees care organised around individuals’ and populations’ health, in which emergency admission is viewed as a failure.
Responding to the challenge of complex long term conditions: Professor Chris Drinkwater, public health lead for the NHS Alliance, argues for a life cycle approach to managing long term conditions which addresses people’s needs as they change.
What is the future for integrated urgent care?: Rick Stern, NHS Alliance Chief Executive, argues that general practice must take a whole system approach to urgent care – starting with a critical look at whether patients can access their services.
Personalisation: Mo Girach explores the implications of personalised healthcare budgets
New ways of working
Medicines optimisation: a new currency for primary care: Mark Robinson, Director of the Medicines Management Partnership, calls for a new approach of medicines optimisation to help ensure good outcomes for patients.
We’d like to share your record with a new expert – you: Dr Brian Fisher, PPI lead for the NHS Alliance and co-director of PAERS Ltd, says it is time to overcome resistance to giving patients online access to their own records – and not just because the government says so.
Shared decision-making: being the change we want to see: Georgina Craig and Dr Brian Fisher argue that shared decision making must become the way we do things – not just with patients, but at community and practice level too.
The future workforce: Sophia Christie, director of UKPrime Ltd, argues that the primary care workforce must get ready for a new technology-based health service, without forgetting the human skills of compassion and caring that lie at the heart of excellent health service experiences.
In two articles, Lynn Young, member of the National Telehealth Forum, and former primary care advisor to the RCN, explores why general practice needs to take up telehealth – but so far has not done so.
Ruth Chambers, GP and Clinical Director of Practice Development and Performance, NHS Stoke on Trent CCG, and Phil O’Connell, Global Project Lead for Simple Telehealth, explore some of the tools and outcomes from using this technology.
Please join the New NHS Alliance if you agree with these values:
- I understand that enabling people to improve their own lives is the most important aspect of a progressive healthcare system (it is more important than ‘improving existing services’)
- I am open to learning and prepared to innovate to find different ways of working that improve people’s lives
- I am open to working with a range of organisations, within and outside the NHS, in pursuit of better health and wellbeing outcomes
- I recognise that people and communities are resource-rich and can hold the solution to improving and preventing poor health behaviours. I am committed to releasing this capacity by enabling people to develop greater levels of Control, Contact and Confidence (the 3Cs of health creation)
- I recognise the emotional labour involved in caring for others and take steps to look after both professional and informal carers
- I believe in and practice parity of esteem between patients and professionals, between the NHS and organisations that contribute to health and wellbeing outside the NHS and between those living with physical and mental health problems