Personal perspectives on the future of primary care

Primary care, and in particular GP services, are increasingly the centre of attention when it comes to reforms to the UK health system.

Those working in primary care face a changing commissioning landscape, increasing numbers of patients with long-term conditions, reduced finances and an ever growing demand on services and resources.

We talked to a range of senior leaders about what they feel are the biggest challenges and opportunities facing the sector in the coming months and years.

David Colin-Thomé, independent healthcare consultant and former National Director for Primary Care at the Department of Health

'The present reform of the NHS is a response to the previous lack of engagement of clinicians, and in particular GPs, in how the system is run. It is after all clinicians, and particularly doctors, who 'spend' the money through their deployment of clinical resources. Of course they should be involved. 

'The promise of clinical commissioners is to establish a different relationship with providers and in particular general practice. The future must be of clinically based relationships underpinned by a contract, not defined by the contract. A clinical led approach to both deliver value in system-wide care and, where care is complex, to contract for individual patients.

'General practice, despite well recognised failings, is the service that continues to offer most value both to its individual patients and the NHS, and uniquely has a formal population responsibility to its registered list of patients. Essential for the future of English general practice is to retain our heritage of being a local resource to our patients and population while being the major influence on clinically-led commissioning. The key challenge is to be both local and small and yet big enough to be the strategically important NHS provider.'

Mark Hayes, GP, Chief Clinical Officer at Vale of York Clinical Commissioning Group, and a Health Foundation Clinical Associate

'Clearly this is a very difficult time for the NHS and we’re feeling that in primary care. It’s up to everyone to pull together to try and work out how we can change things to make them sustainable into the future.

'Money is one of the main challenges. It’s likely there will be no growth in the health service budget for the foreseeable future, and it might even shrink in real terms. So we’ve got to find ways of doing more for the same money, or even less money. Locally we’re also facing problems recruiting GPs. The days when you had 30 odd applicants for a partnership are long gone, and if you can’t recruit people then you can’t provide the services.

'We also have an issue around premises. Practices must become bigger to justify the full team of staff needed to deliver the range of primary care services now expected of us. Our current buildings don’t always suit the needs of modern-day practices.

'On a more positive note, we have a real opportunity to change the dynamic of the doctor/patient relationship in primary care – moving to a much more patient centred approach where the clinician is an equal partner with the patient, helping them to manage their own condition. Achieving this shift across the NHS will have a beneficial effect on the workload in primary care. We’ll spend less time seeing people over and over again and not really getting to the bottom of their problems, giving us more time for the difficult cases.'

Peter Chamberlain, GP, Clinical Commissioner for South Sefton Clinical Commissioning Group, and Clinical Tutor at the University of Liverpool Medical School

'GP colleagues tell me the biggest challenge facing practices right now is being able to meet patient’s expectations of how care should be provided. Patients are being encouraged to act like consumers of healthcare, as opposed to partnering effectively with their GP to ensure that their needs can be met within the resources available.

'The other big issue is of course commissioning. Not all GPs asked for this responsibility or feel they have the skills to do it. They can see the money reducing and their clinical workload increasing and also know they’re now being held responsible for the outcomes of the NHS. There’s anxiety around whether clinical commissioning groups can deliver on a scale that will actually save the NHS from the burdens of a changing demographic and the increase in long-term conditions. Unless we can manage more efficiently on the resources we’ve got, we’re going to end up in a very difficult situation.

'But let’s be positive. Some of the solutions are a lot closer than we think, we just have to be bold about empowering patients, and be willing to work together.

'We know that a health system so heavily weighted on hospital care is unsustainable. We have a real opportunity to bring care closer to home by integrating services from the acute trusts within primary care. Doing this properly will mean patients can access care quickly, closer to where they live, and avoid admission to hospital, making a real difference to patient’s experience and outcomes.

'We should also be integrating more within different primary care services and by linking with social care and the voluntary sector. This is a chance to really streamline and wrap the care around the patient. I think IT developments will also bring about new breakthroughs, for example carefully opening up access to people’s medical records.'