Where next for primary care – can the Fuller stocktake answer pressing challenges to reform?

By James Hollaway

With the primary care ‘stocktake’ inquiry, led by Dr Claire Fuller, due to report imminently, we look ahead to what is on the horizon for primary care and ask whether Sajid Javid can achieve the change needed to drive forward health and care reform.

In his speech to the Royal College of Physicians in March 2022, Sajid Javid was expected to unveil extensive plans to reform primary care. In the immediate wake of the pandemic, a focus on streamlining primary care and supporting general practice to better manage and respond to the backlogs and waits that have developed from COVID-19 was a clear area of focus for the Department of Health and Social Care.

These reforms, which the Health and Care Secretary outlined in a letter to the Prime Minister in early 2022, were intended to focus on ‘nationalising’ GP practices, incentivising surgeries to integrate into hospital trusts, rather than operating as small, independent businesses – as has been the case since the founding of the NHS in 1948. The emphasis was to be the enablement of a greater focus on prevention, streamlining the work of general practitioners and creating capacity to drive forward a new prevention agenda.

Whilst the announcement on primary care reform did not make it into Javid’s final speech, it is likely that primary care will nonetheless be a focus for reform and attention in the coming months. The speech set out the future direction for health and care services – underlining a commitment to prevention and personalisation. As a gateway to other health services, primary care will naturally have a central role to play in achieving the progress that the Health Secretary outlined – and the question is how this can be achieved against the backdrop of severe pressures that have deepened over the course of the COVID-19 pandemic.

Challenges in primary care were known prior to the pandemic, with the NHS Long Term Plan underlining that younger GPs were less interested in taking on the traditional partnership models used to run practices. In 2018, data from NHS Digital underlined that GPs were increasingly taking early retirement, with a threefold rise occurring over the previous 10 years and an overall stagnation in the size of the GP workforce contributing to a significant decline in the number of GP partners.

The pandemic has served to make pressures in general practice more extreme. In a recent poll 77% of UK GPs referenced workforce shortages as an issue that is putting patient safety at risk, and with some areas currently having no permanent GPs in place, urgent consideration of the future of primary care is needed.

As it stands, primary care sits at the heart of wider reforms and ambitions in health policy. The implementation of Integrated Care Systems in July 2022 will position Primary Care Networks as a crucial structure for delivery against a number of goals, including efforts to tackle deep-seated health inequalities and an overarching focus on disease prevention.

The challenge to achieving these ambitions is likely to be successfully creating the capacity within services to undertake these new objectives, when they are only just coming out of the immediate response to the pandemic, with considerable workforce deficits and, in many cases, accommodating the consequences of restricted access to care across local populations during COVID-19.

So, what might be on the horizon for primary care? Dr Claire Fuller’s ‘stocktake’ review of primary care is expected to be published imminently and will identify next steps for the role of general practice within new Integrated Care Systems. It is likely to put forward innovative approaches for the delivery of care to patients that address the pressures created by COVID-19. Spanning nine workstreams, from community engagement, to digital infrastructure and consideration of the physical primary care estate, the review will set out how primary care can support the goal of health and care integration.

Whilst the Fuller stocktake is unlikely to focus on major structural reform in primary care, there are expectations that the review will make recommendations on how to better facilitate different ways of working across primary care teams, seeking to join-up services within ICSs with a particular focus on managing patients in need of urgent care.

With the advent of Integrated Care Systems and the ongoing drive to recover services from the pandemic, what is already known is that primary care will need to change in order to achieve the capacity it needs to drive forward the government’s health agenda.

Javid clearly has hurdles ahead when it comes to achieving this goal, as he grapples with the numerous issues that lie in the wake of the pandemic. From cancer targets, to reducing waiting times for elective care, to levelling up the health of the nation – all would be made easier with a resolution for primary care and all stand in the way of carving out the necessary energy and capacity for primary care reform. This is an irony that is perhaps not lost on the Health Secretary and an issue he is likely to revisit following Dr Fuller’s review.