The NHS 10-Year Plan has been announced at long last and there's a lot to dissect. Plans to roll out all-new neighbourhood centres firmly captured the media's attention, but I can't help but feel they'll be very difficult to put into practice. Our burdensome primary care system is already giving existing healthcare providers a headache – if Streeting wants to get these centres off the ground, he'll have to strip the system back.
Under the status quo, the primary care system is a slow-moving and oftentimes impenetrable maze of different bodies, boards and trusts. ICBs control NHS services across local areas, local authorities often preside over ICPs which develop care strategy, and underneath all that, we have PCNs – groups of GP practices and other providers working together to deliver services across populations of about 50,000.
That's just a high-level overview of the most prominent players across primary care, so imagine how convoluted these structures can be when you delve beneath the surface.
Such a knotty system does not come without consequences – in fact, GP practices have been bearing the brunt of this issue for years.
For instance, currently funding gets tied up at every level of the primary care chain. There are countless well-meaning financial schemes available to support practices, but they almost always fall victim to these complex structures.
Take the Additional Roles Reimbursement Scheme (ARRS), for example – a scheme that is supposed to help PCNs recruit extra GPs, practice nurses and pharmacists, among other roles. In theory, it's a great idea, but a lot of its value gets squeezed out as the funding moves through the system.
ARRS cash starts with NHS England, is passed down to ICBs to hold onto and then reimbursed to PCNs months after an actual hire has been made. In fact, the average PCN has to fund £180,000 worth of staff costs in arrears, long before they actually receive the money. It's a hugely inefficient way of getting funding through to healthcare providers.
On top of this, complicated conditions are attached to the funding at every level, making it difficult to incorporate into financial planning. These challenges are a direct consequence of having a complex, tangled primary care system and mean that many practices and PCNs make far less use of the ARRS scheme than they perhaps should.
That's just one illustration of the impact the complicated system is having on our existing healthcare providers. For me, the process of rolling out all-new neighbourhood health centres is sure to be hindered by the same challenges.
To give these local hubs the best chance and to support GP practices as they gear up to take on more of the NHS load, I'd like to see the Government do far more of what we saw back in March. Starmer pledged to axe NHS England (NHSE), stripping away at least one of the blockers to implementing successful healthcare policies.
Though questions remain over how, when and if the Government can remove NHS England seamlessly, the intentions behind the move are right. The healthcare system as a whole has become an inefficient beast and abolishing NHSE was the first step in stripping it back to its roots. Now we need to see Starmer and Co take the same approach to primary care.
The problem is the Government had an opportunity to go further and remove more bulk from the healthcare system in the 10-Year Plan – they just chose not to. In fact, far from simplifying the primary care structure, policymakers appear to be complicating it even further.
The plan contains proposals to introduce new types of contracts for what are being termed single neighbourhood providers. These will cover populations of around 50,000, while multi-neighbourhood providers will be responsible for services for around 250,000. We can only guess at how these new organisations will work alongside existing PCNs and how new contract types will impact family doctors.
Further still, the Government has outlined plans to award some of these contracts to hospital trusts, bringing them deeper into the primary care tangle. Rather than cutting the number of organisations, they're adding to it.
Of course, as is always the case, there is a serious lack of detail in Starmer and Streeting's 10-Year Plan. It's not entirely clear how these new providers and trusts will fit into the already overcrowded picture but what I do know for sure is that these plans will make primary care even more complex.
Look, it's not all bad news. GPs were awarded a significant funding uplift this year – to the tune of £889m – and the spotlight shining on primary care is something to be celebrated. Things are looking up, but I know from firsthand experience that family doctors and PCNs would be able to make the extra funding go further if primary care structures were easier to navigate. They'd be able to plan and budget more effectively to deliver better healthcare even faster.
Adding more and more layers to the system is not the way forward. It will only hurt existing providers, not to mention completely unravel the Government's much-touted neighbourhood health centre plans. If they're to make any progress, the complicated primary care web needs stripping back.
For me, the 10-Year Plan was a missed opportunity. Without going back to basics, I fear its promises will have little chance of becoming reality.
