The NHS at 75: the case for primary care

Primary care and general practice in the UK are regarded as among the best in the world. But, at 65, the NHS is under unprecedented pressure, so GPs do not have much time to rest on their laurels.

The outlook over the next 10 years, as outlined in our report NHS@75, demands radical change in how we think about and deliver care. Rather than shying away from this, a GP led renewal of primary care must be at the heart of the vision for the NHS in 2023.

‘GPs have a strong foundation to develop a pivotal role in delivering integrated care through a collaborative model’

The overwhelming majority of people’s interactions with the health service are with primary care: general practice accounts for 90 per cent of activity, although only 8 per cent of the NHS budget. The relationship between patients and GPs is highly valued, as recognised by the recent announcement on assigned GPs for the over 75s.

Success factor

But changing demographics and tightening budgets threaten to overwhelm the current model. The challenge is to find sufficient scale to innovate, while retaining the best aspects of today’s approach.

GPs have a strong foundation to develop a pivotal role in delivering integrated care through a collaborative model, reversing the recent trend of practices increasingly losing touch with the extended primary care team. 

International examples point to common factors of success. The GP owned Midland Health Network in New Zealand brings together 100 GP practices, covering 500,000 people. Collectively, GPs can strategically plan the provision of primary care services. They are the hub of a network of integrated primary care provision, linking social care, mental health and elderly care professionals, and public health promotion services. 

Pioneering programme

Closer to home, a “super“ partnership brings together GPs in Sandwell and Birmingham, who are pioneering an integrated care programme with the help of other care professionals. 

‘The future NHS relies on having thriving primary care at its heart’

While we can look to examples of good practice, this is not about creating a single blueprint for primary care: there is a need to support primary care to innovate and develop from the frontline up. 

Where practices do try to merge or create solutions around local issues, they often find statutory stumbling blocks that disable rather than support innovation. Instead, a principle of “general power of competence” should apply, as long as solutions are in the interest of improving outcomes. Clinical commissioning groups, although not direct commissioners of primary care, should work with their area teams to support innovation.

GPs might need help such as technical expertise around organisational design, legal advice and estate management, and support on cultural issues associated with new ways of working.

The future NHS relies on having thriving primary care at its heart. The case for change has been made; now is the time to take action.

Dr Tim Wilson is a partner and Janet Dawson is healthcare lead partner at PwC