The Week

The Week 12 May 2023

Sebastian Rees
Senior Researcher

Access to primary care has long been deteriorating in England and patient dissatisfaction with general practice has reached peak levels. Reform was therefore pleased to see NHS England publish its long-awaited primary care access plan this week.

And as far as NHS England plans go (we’ve been a little critical in the past) this one doesn’t shape up too badly. There are some commendable commitments here. Improving digital capabilities in general practice has been a long-term interest at Reform. And though the recommendations here — putting in digital phone systems which can queue and route calls and fixing (often woeful) GP practice websites — aren’t game-changers, they’ll certainly help ease the frustrating 8am rush.

Pledges to cut burdensome bureaucracy between primary and hospital-based care, expanding the offer of the NHS app and bringing in more short-term workforce capacity (see this thread on “SAS” doctors, one of the floated ideas), all make good sense to ease the burden on a system under huge pressure.

The two major reforms announced here — expanding the role of community pharmacy and improving care navigation in general practice — are worth exploring in more detail. They are the right direction of travel but will need to be carefully thought through. Moving more services into pharmacy is convenient for patients and likely to drive down costs. However, the £645 million allocated over two years in this plan (around £30,000 per pharmacy, annually) may prove insufficient, particularly if new staff need to be recruited to meet demand. Though securing long-term investment in a pressurised system is difficult, a greater upfront commitment may be required to pay dividends later on.

Improving care navigation — directing patients to the most useful service within or outside of a practice team — must be at the heart of a new primary care model. Launching a National Care Navigation Training programme offered to 6,500 staff is an important first step. But the transformation of the receptionist role that this entails raises questions about capacity to meet day-to-day administrative needs. It will also require thinking carefully about communication with patients who may be uncomfortable sharing information with non-clinical members of the practice team.

Of course while all this is welcome, primary care actually needs a much more long-term vision — shifting the balance in the NHS away from hospital-based specialists and towards community-based generalists is vital for building a sustainable health system fit to meet the challenges of an ageing population. Does this plan get there? Not really. But it sets out some very important first steps.

Onto the read of the week...

Our recommended read for this week could only be the leaked draft Labour manifestoLabour List, who have seen the draft and summarised the policies contained in it, stress that the proposals still have a three-stage vetting process to go through to make the manifesto (the National Policy Forum, Party Conference and a 'clause V meeting'), but the document nonetheless is a useful indication of what to expect.

Most of the potential commitments have already been well trailed — a Take Back Control Act to further devolution, 13,000 more neighbourhood police officers and PCSOs, doubling the number of medical school places, and introducing free breakfast clubs in every primary school — and some are as vague as to be meaningless — “treat mental health as seriously as physical health”, “Ensure that the probation service is run effectively”, “Harness the potential of AI for public good” (hear hear!…how?). But overall its a must-read document for those of us interested in what Labour's policy platform might include heading into the general election.