By Professor Robin Miller
School of Social Policy, University of Birmingham
General practice in the United Kingdom has long had an international reputation as a positive exemplar of primary care. Free at the point of access, funded on basis of population and needs (i.e. not a fee for service), and led by clinicians, our model is seen to have a better chance than most of providing the support that is preventative, coordinated, and with continuity of care.
Over recent years, it has become apparent that our traditional model will struggle with expected demographic changes such as an ageing population, the rise of obesity, and increasing people living with multiple long-term conditions. These combined pressures are indeed leading to frustration for patients in relation to accessing appointments, and considerable stress for general practice.
Health policy in the UK is the responsibility of the home nations, and each country has begun to introduce new visions for primary care. Whilst each of these has their national distinctiveness, they all follow a similar set of assumptions regarding how best to make primary care sustainable and person-centred. These include enhancing the contribution of other professionals alongside general practice, connecting health care services better with community resources, and supporting people to take greater responsibility for their own health and wellbeing. This reflects an international interest in such models, often described as ‘patient centred medical homes’.
To achieve this vision, Wales launched a national plan in 2015. This included a development fund of £120 million, clusters of wider primary care services and other partners around identified communities, and a national workforce plan to support the development of multi-professional teams. The subsequent Strategic Programme for Primary Care in 2019 further built on these initiatives through an enhanced, community-based model of Primary Care. This model arose in part through the national Pacesetter Programme in which local health boards received funding to support innovations within primary care.
Research by University of Birmingham of the programme found that whilst it had enabled some positive developments, overall it was hampered by a lack of clarity about its objectives, insufficient evaluation capacity, and underdeveloped opportunities to share learning. A recent report by the Auditor General for Wales has again underlined that implementation of the vision was not happening ‘as quickly or widely as intended’ (p11).
Such implementation difficulties, and in particular the challenge of ensuring that best practice can be applied consistently across all localities, are being encountered within the primary care transformation programmes in England, Scotland and Northern Ireland. Insights from international exemplars highlight that the approach to change is as important as the new ways of working being introduced.
The common aspiration across the UK to transform primary care should provide many opportunities for shared learning about how to undertake such change – it is vital that universities work together with practice and policy colleagues to realise this opportunity, and ensure that primary care in the UK remains in good health for decades to come.