Viewpoint: why primary care is key to easing NHS pressure

Primary care can play a key role in easing pressure on the NHS if politicians build on its potential, argues NHS Confederation director of policy Dr Johnny Marshall. Writing for, Dr Marshall explains why the NHS Confederation wants GPs to adopt a 'population health approach'.

Dr Johnny Marshall: GPs can ease pressure on NHS

We all know that rising demand is putting pressure on the NHS and that changes to our healthcare system are needed. In the UK, GPs have long been the gateway to unlocking services for patients while enabling the system as a whole to manage demand efficiently.

But general practice, like all other parts of the health and care system, is having to deal with pressures on resources while keeping pace with changes in technology and treatment options, and supporting a growing number of patients with multiple long-term conditions and increasingly complex needs.

Time for change

A changing population, and changing care system, needs general practice to change too. I strongly believe that our model of general practice, far from being the cause of current system pressures as some would have us believe, is pivotal to finding the solutions.

Wrapped up in general practice is knowledge and a place in the community that brings invaluable understanding of local health needs and significant public trust. If it can build on these foundations, in particular by adopting more collaborative ways of working by embracing partnerships with social services and the voluntary sector, general practice is ideally placed to support the new models of health promotion and healthcare that the NHS needs.

That's why the NHS Confederation has responded to NHS England's Improving general practice - call to action, by asking general practice to embrace a population health approach. This isn't just about improving general practice itself, but ensuring primary care teams support success across the whole of the NHS and wider care system.

Each geographical area has a unique set of socio-economic factors and local service issues. General practice is ideally placed to understand those priorities by using the unique local knowledge and population-level data to address health and wellbeing. We can prevent the preventable as well as delivering the right care when and where people need it; and we can tailor services around the resources and needs of the population, from cradle to grave.

Close to home

We know that patients want to be treated closer to home when possible rather than end up waiting in A&E or being needlessly admitted to hospital. But patients do not always believe that existing community services are able to meet their needs or feel informed to make that decision. General practice needs to play its part in providing more responsive primary care and assurance that using community services is often the quickest and safest way to look after their health.

It is clear that the intentions behind the announced changes to the GP contract for 2013/14 are to encourage general practice to play an even stronger part in delivering enhanced community services. But I believe change will only really happen if we can find a better way to co-ordinate the commissioning of primary care by NHS England with CCG commissioning of acute and community services. This came through as one of the strongest messages in NHS Clinical Commissioners’ recent survey of CCGs, and so I welcome last week’s announcement that changes will be made to the Health Act to support more integrated commissioning.

As well as aligning funding and resources, data must be available and shared securely between organisations to inform the decisions about both individual patients and the wider population. There must also be more flexibility so that staff from different sectors and organisations can work across the system to share their knowledge and expertise to benefit patients. This in turn requires workforce development and training programmes that inspire and prepare GPs, practice nurses, allied health professionals and support staff based in primary care to innovate, scale up their own services and work more effectively with each other and as part of wider integrated teams.

Whole system approach

The potential benefits of this approach will only be realised if the whole system responds, but either way, it is time for the politicians to stop describing general practice as the problem and start building on its potential to unlock solutions. If the NHS is to remain sustainable, free at the point of use and one of the most respected and equitable healthcare systems in the world, now is the time to make the vision of population-based, community-led general practice a reality.

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