Primary Care Networks as a response to the winter healthcare crisis
General practice sits at the heart of the NHS and is often first port of call when illness strikes. The service delivers accessible, whole-person care to local communities but in recent years has felt the impact of chronic underfunding, an increasingly complex workload and falling GP numbers. Little surprise therefore that when winter comes an already stressed system is further stretched leading to the healthcare crises that feature regularly in newspaper headlines.
The decision to prioritise investment in general practice in the NHS long-term plan (LTP) is a welcome first step. However, funding alone will not be sufficient to avert the winter crisis or the other deep-seated problems currently affecting healthcare delivery in primary care. The LTP has called for the establishment of Primary Care Networks to strengthen collaboration between practices allowing pooling of staff and resources. Properly funded networks are a key innovation for meeting contemporary service requirements and the extra demands that winter brings.
Tower Hamlets where I work as a GP has a diverse population with some of the worst health inequalities in the UK. Yet, the CCG delivers excellent health outcomes for all, with a top three ranking nationally against 10 of the Quality Outcome Framework (QOF) clinical measures. Central to this success story has been the long-standing establishment of eight borough-wide GP networks with more recent federation of all 36 practices in the Tower Hamlets GP Care Group. In 2015 network activity was strengthened when Tower Hamlets became a “vanguard” for the new care-models programme of the NHS Five Year Forward View, aimed at improving health and wellbeing of the local population through partnership between the Care Group, CCG, local authority and local acute and mental health trusts, as well as key partners in the voluntary services.
These collaborations have worked to relieve pressure on services in a variety of ways. For example, confusing arrangements for accessing urgent care, which led to clogging of local A&E departments, have been simplified by the introduction of the new NE London-wide 111 service. This has potential to provide 24/7 advice for patients with signposting to the appropriate emergency service. Most importantly, a GP hub now operates in each network providing additional “overflow” appointments as well as more choice of times to be seen. A&E can now book those patients better seen by their GP directly into appropriate appointments either with their own surgery or a hub as well as registering un-registered patients with local practices. Use of telephone triage by practices has further improved service delivery by directing patients to appointments with the correct healthcare professional, the emphasis moving from first-come-first-served to access based on clinical need.
The effectiveness of streamlined healthcare through networked practices depends on patients obtaining access to the appropriate healthcare professional. This is not always the GP. Reception teams are being upskilled to triage calls to the appropriate professional, including allied health professionals: nurses, pharmacists, physician associates and others, many employed through networks to ensure services are maximised across all Tower Hamlets practices.
These innovations have been underpinned by a strong quality improvement programme, EQUIP and multi-professional protected learning time through the community education provider network (CEPN). Technology is being used to bridge the gap between acute, primary and community sectors through the Communicate and Educate initiative which allows healthcare professionals to join the numerous educational events virtually, improving staff morale and ultimately benefitting patient outcomes.
Network collaborations such as those we have pioneered in Tower Hamlets are already having a profound impact on quality of care and are key to our response to the winter healthcare crisis. However, while extra primary care funding from the LTP is welcome, it falls short of the historic average and of what the experts estimate is needed. This will be further exacerbated if social care and public health continue to be underfunded given the background of rising poverty with widening socioeconomic inequality. Failure to address issues outside the control of the NHS will continue to place significant extra pressure on front-line health services and impact on the success of any innovations.