Viewpoint: Francis inquiry impact must extend to primary care, says Lord Howe

A year after the landmark Francis inquiry exposed hospitals' failings and called for a culture change in the NHS, health minister Lord Howe reflects on the lessons for primary care.

Lord Howe: Francis inquiry lessons not for hospital sector alone (photo: Jason Heath Lancy)
Lord Howe: Francis inquiry lessons not for hospital sector alone (photo: Jason Heath Lancy)

In the past eighteen months, the NHS has had to respond to the darkest episode in its history. The Francis Inquiry laid bare devastating failures in acute hospital care and called for a fundamental change in culture.

Twelve months on from the first Francis report, the NHS has made huge progress. We have a new inspection system, more nurses on the wards, evidence of real cultural change and a whole programme focused on turning failing hospitals around. But looking to the next 12 months, I believe we need to widen the focus and ensure that the impact is felt more fully across primary care.

GPs are now in the driving seat. As members of a CCG, they commission hospital care, make referrals to hospitals and community services, and take the decisions that have the greatest impact on patient care.

The Francis report only made one recommendation that is specific to GPs, but it is a big one. It said that GPs need to undertake a monitoring role on behalf of patients receiving acute hospital care or other specialist services.

From 1 April, GPs will be required to monitor the quality of out-of-hours services and take action.

GPs can also learn lessons from other Francis recommendations. The inquiry found that patients’ voices were all but lost at Stafford hospital. From December 2014 we are rolling out the Friends and Family Test to GP practices. It is already making a difference to hospitals, which are making changes based on patient feedback. Apparently simple changes, like making meal times more flexible, have made a big difference.

The inquiry also stressed the importance of transparency. Only by being open can we learn from our mistakes. This means listening to staff and patients.

Steve Field, the chief inspector of general practice, will be designing a new system of inspection to help expose poor care and encourage improvement. By April 2016 all surgeries will have been inspected and reported on.

Hospitals alone can enact huge change, but primary care is crucial. I see the remarkable work that GPs do through my visits to surgeries. I look forward to seeing them make even greater strides over the next 12 months.

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