Covid-19: Primary Care Networks are galvanised, but will we have enough primary care?
By Dr Hannah Morgan
GP partner and Clinical Director, Hayling Island and Emsworth Primary Care Network
General Practice provides 95% of urgent, same-day care. In March, we questioned whether there would be enough ventilators for the people that needed them. Our questions were pivotal, not just for Covid-19, but for the NHS system working across Portsmouth and South East Hampshire. It felt important that our primary care, acute and system leaders vocalised the aim that no patient, where appropriate, should go to hospital without being triaged in primary care first. The ‘111 first’ initiative is now being rolled out in our area, the first in the country. Those initial questions and subsequent conversations emphasising the ‘national’ component of the National Health Service helped us to find the middle-ground.
Last year, the foundations for fast-paced collaboration were laid with the formation of Primary Care Networks (PCNs). In South East Hampshire, the determination to protect our acute trust throughout the Covid-19 crisis has remained the core issue in our twice-weekly team calls. PCN clinical directors know our GP practices and are working with our community partners (voluntary and community organisations, councils, commissioners, acute clinical and medical directors). This helps relationships to develop on an individual level as well as through services and spheres of influence. We can work individually but also form a collective mandate. This has made a tangible difference to unpick clinical/service discussions. Vitally, it also brings camaraderie, which gives us presence and psychological safety.
Primary care needs to continue delivering same-day care but also be able to get back to dealing with undifferentiated symptoms, long term condition management, wellbeing concerns and prevention. We entered the pandemic with a workforce crisis for GPs and community nursing, as well as an estates problem. We now have the added issues of social distancing and increasing unmet need, but also some solutions for remote working. We have our amazing practice managers, primary care and commissioning teams, as well as funds for recruitment. My PCN, like most others, lacks the infrastructure and expertise to work alone, which is a silver lining for promoting collaboration.
In other parts of the system focused mainly on acute need, there are expert data-analysts, planners, digital experts, educators and commissioners. We now urgently need to find headspace to collaborate to solve the primary care issues we cannot achieve on our own. Primary care modelling and estates issues must now be taken off the ‘too difficult’ pile and PCNs are our way in. If we cannot solve our estates issue, I cannot use our funds to recruit, as I have nowhere to put staff. At present we know most of our estates are not sufficiently viable, unless we work very differently. We need to be modelling demand and capacity to know how best to plan and do this. If the system does not help, we may well overspill, when this could have been avoided.
As we continue to galvanise around Covid-19, the next pivotal question for our systems is whether we will have enough primary care? If we could commit to ensuring this as a shared system aim, like we have with shielding our acute patients and organising our ventilators, it would serve us well. Can we persuade our NHS leaders to prioritise primary care and lean their resources into helping us? And how quickly can we fill the void of reliable data for demand/capacity for primary care?