Future Investment into Primary Care


Over the course of the past fifteen years, the NHS has dramatically improved, offering shorter waiting times and better outcomes in areas such as cancer and cardiac disease with higher patient satisfaction. However, the NHS is preparing to undergo significant internal restructure in order to deliver the objectives set out by NHS England in their report ‘five years forward view’.

Five years forwards view

The report explains the need for change in order to adapt to a growing population, an aging population and a new generation with 21st century health needs. The NHS needs to take advantage of the opportunities presented to patients arising from developments in science and technology. The vision outlines three specific areas for reform; health and wellbeing, care and quality and funding and efficacy.

Health and Wellbeing

The future health and sustainability of the NHS as well as the economic prosperity of the Britain depend upon an upgrade in services dealing with prevention of avoidable illnesses. The report sets out priorities in tackling the risks of ill health which come about as a result of poor lifestyles by incentivising and supporting healthier living and delegating responsibility to local democratic leadership on health related issues in particular areas. Significantly, the NHS is set to target prevention of illnesses by having a proactive primary care system.

Care and Quality

The NHS will steer away from the traditional divide between primary care, community services and hospitals. New models of care will be created to improve the quality of care and patients’ experience. However, the diversity of our Country means that it is impossible to take a ‘one size fits all’ approach therefore there will be a variety of models which apply to different parts of the Country depending upon specific needs.

The most important change will come through the achieving the Government’s objective to expand and strengthen primary and out of hospital care. The NHS will take steps to give GP-led Clinical Commissioning Groups more responsibility over wider NHS budget and work with those groups to encourage and incentivise practices to provide care in under-resourced areas. Additionally, changes will see increased investment in new roles, upgrading of the primary care infrastructure and scope of services, as well as building upon the public’s understanding of healthcare resources for minor issues which can be dealt with without the need to see the GP or visit A&E.

Funding and Efficiency

To achieve the changes outlined in the report, the NHS will require new partnerships with the local community, local government and employers. Such partnerships will have to fit with the new care models. In order to do so effectively, funding will need to be carefully allocated.

The Government has shown their support for the vision by providing an additional £2 Billion of funding in the Autumn Statement. Health Secretary Jeremy Hunt delivered a statement to Parliament announcing that the additional funding will be used to implement the vision set out in ‘five years forward view’. In particular, Mr Hunt presented to Parliament that the bulk of the funding would be used to support and modernise the frontline care and new primary care infrastructure. Additionally, some of the funding would be used in piloting the new models of care.

What does this mean for primary care?

The NHS commissioning system currently has Clinical Commissioning Groups (CCGs) which are clinic-led statutory bodies which provide primary care on behalf of the NHS throughout the country. Essentially the CCG’s work closely with local authorities and NHS England and are responsible for planning and commissioning of health services for their local area.

Potential changes will see extensive responsibility delegated to CCGs to provide more health services such as core general practice, including responsibility for the budgets in such areas. Despite concerns that GPs involved in CCGs may create conflicts of interest and damage reputations, or reservations from some CCG’s that they do not have the capacity to take on the more extensive role, CCGs are encouraged to maintain involvement in commissioning general practice, and in future primary care. The extent of such involvement would include, but is not limited to: setting out strategy, negotiating contracts and improving care quality. Much thought should be given to the important point that should the changes occur, the extensive responsibilities delegated to CCGs will have an effect on how the CCGs are governed. Rather than the CCGs being led by GP practices, CCGs will consequently obtain significant powers over GP practices.

There has not, as of yet, been any decision made in relation to such changes; however, a large proportion of funding is being passed to CCGs and for that reason it is likely that the changes outlined above will be imminently rolled out.

The ‘Five Years Forwards View’ also illustrates new models of care including new approaches to commission health care providers, for example, the use of large organisations taking part in planning and budget responsibilities. CCGs are likely to be expected to be able to accept and take on such approaches which, on the face of things, would seem to significantly alter the CCGs function. However, such an approach may alleviate some concern for CCGs who believe they have no capacity to take a more extensive role. Less involvement would be needed from the CCGs should the large corporations take on tasks such as planning and budget responsibilities.

The government’s aim to improve primary care and out of hours care will in turn have an impact on secondary care. Such a development would see an important connection between healthcare sectors; however, this would consequently require an increasing role of CCGs.

The proposed framework would put a wide range of responsibilities on CCGs; however the NHS would have full oversight of such implementation and require frequent formal reviews. Therefore, CCGs who are struggling or have severe problems in the administering of their duties will be able to rely upon the NHS for support.

It is unclear as to how the Healthcare commissioning system will develop over the next ‘five years’, however, what we do know is that there seems to be a lot of enthusiasm for change. If the changes are successful, it can be said that the NHS will be dramatically improved. Nonetheless, the general election in May 2015 may have some impact on how these potential changes develop.

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