Earlier this month, the much-anticipated model ICB blueprint was published by NHS England and was quickly analysed across the health service. The blueprint suggested greater emphasis on provider-driven design and delivery, with plans to transfer numerous functions and activities out of ICBs to providers.
Among the list of functions listed for ICBs to transfer over time, a number will have caught the attention of primary care leaders. The introduction of ‘neighbourhood health providers' – which although not explicitly defined in the blueprint, will naturally ignite a debate on how best to deliver a neighbourhood health service.
Lord Darzi's review last autumn described general practice as having the best financial discipline in the health service – despite a reduction in the relative share of the NHS budget being spent on primary care. Yet primary care leaders often air their frustration at their voice being lost in system conversations and while historically the well-established infrastructure that makes up statutory NHS trusts has been hard to replicate in primary care, now could be the moment of opportunity.
With the model ICB blueprint signalling a shift towards provider-driven design and delivery, primary care should use this opportunity to create the infrastructure required to deliver this shift. At a time when the system needs the entrepreneurialism and agile nature of primary care more than ever it's vital that their voice and influence in system redesign isn't lost.
That is why in my view, primary care must move towards establishing, or enhancing existing, primary care provider collaboratives (PCPCs) so that they can be an at-scale delivery vehicle and move beyond advocacy alone.
Primary care needs to speak with a collective voice, and one that commands legitimacy from commissioners and system partners to ensure there is a seat for the primary care representatives at the table – this includes community pharmacy, dentistry, optometry and audiology. The potential they have to lead the way on delegated functions such as vaccinations and immunisations is huge, driving significant uptake and coverage through collaboration.
The top priority for primary care leaders
Over the past year the NHS Confederation's primary care network (PCN) and KPMG have worked in partnership setting out what is needed to realise the potential of PCPCs and to accelerate their development – with valued input from our members.
PCPCs are fundamental to the successful delivery of a successful neighbourhood health service - shifting care from hospitals to community, reducing health inequalities and ensuring that everyone has access to high quality care. By bringing together primary care providers from across the sector – collaboratives can be a powerful integrator for community-based care.
To do this well, strong relationships with system partners, including the VCSE, are needed as is a genuine commitment to collaboration over competition.
Birmingham and Solihull Community Care Collaborative is a great example of this, bringing together primary care, community health services, community mental health, social care and the community and voluntary sector. Birmingham Community Health Services NHS Trust is providing the organisational framework to make this happen.
In other areas PCPCs have set themselves up as Community Interest Companies (CICs), which allows them to hold NHS contracts, as seen in Milton Keynes PCPC.
In Herefordshire, the emerging PCPC is built around Taurus Healthcare, the PCNs, GP practices and the local medical committee. This enables them to provide 24/7 general practice services, working with partners across the system in both NHS to support care closer to home such as their integrated urgent care model.
And in Sutton the PCPC is built around the existing PCN infrastructure, forming a ‘network of networks' as a CIC.
ICBs have an important role to play in this in working with and enabling primary care to build the infrastructure for the future. In Hampshire and Isle of Wight, for example, the ICB is actively supporting the development of a PCPC through the creation of a pathfinder board, which serves as an initial step towards a formalised collaborative structure.
PCPCs offer an opportunity to truly transform primary care delivery, acting as the essential infrastructure to deliver the Government's left-shift agenda. The sooner we embrace this model and prepare for the future, the better positioned we will be for a future focused on value, quality and collaboration. In the new provider-driven delivery landscape – the time for action is now.
