The long-awaited Fuller stocktake was released yesterday. Dr Claire Fuller, Chief Executive-designate Surrey Heartlands Integrated Care System, was tasked with understanding what is and isn’t working well in primary care, and how change can be accelerated.
Below the ZPB team have pulled out our main takeaways for our Friday Five:
Approval from ICS CEOs
42 Chief Executive designates of the Integrated Care Systems have all signed a letter showing their support for the vision and framework laid out in the Fuller stocktake.The letter states: ‘Today we are making a personal commitment to take forward the actions in our own systems in all our neighbourhoods. It’s foundational to everything we do.
‘This support from across the regions cannot be overlooked. Very rarely in the NHS do we see this unified level of support, which further stresses the need, and want, for change.
Read the CEO letter here.
Continuity of care
Fuller identified continuity of care, the continued relationship between a clinician and their patient, as a core element and benefit of primary care.
Fuller said: ‘It is vital that we retain continuity as one of the core strengths of primary care, but we must also recognise that people’s needs and expectations are changing. On the one hand, a growing number of people have complex needs, such as multiple long-term conditions, requiring highly personalised care and support. On the other, many people who are normally in good health would prioritise faster access to advice from a wider group of professionals.’
She added, ‘Not all patients want or need continuity of care; equally some patients may want continuity of care more generally but be happy to see different professionals as part of their overall care.’
Personalised care is therefore the key takeaway here. We need to identify those patients who have the greatest need for continuity of care and ensure it is available for them.
Workforce
The NHS is currently facing challenges due to capacity gaps from extreme demand in primary care, especially following the pandemic. The gaps were already growing in the decade before COVID-19 due to workforce pressures and reduced staff satisfaction and the increasing number of people living with multiple long-term conditions, and changes in public expectations.
The report said ‘A new care model will not magic away our workforce challenges: we need to continue to grow the MDTs in primary care and recruit and retain as many extra GPs as we can possibly get. The plain fact is that the aggregate numbers of GP full-time equivalents (FTEs) are simply growing too slowly and we will need more action at every level to address the gap’.
Fuller also discussed the fact that the record-high number of GP trainees masks the loss of fully trained GPs, which puts a strain on primary care.
The shortfall of GPs needs addressing as an urgent and essential priority.
Estates
‘Estates are so much more than buildings. We must move to a model that makes estates a catalyst for integration rather than a barrier to it. This new model should focus on patient needs, create a positive working environment for staff and provide adequate space for key activities like training and team development. Creating the right environment has to start with understanding what we have got in terms of estates, something that is best undertaken locally’.
The current mindset and approach to estates must change to create the permissions and support for local systems to build estates models that better align with the delivery of clinical, digital and workforce strategies.
Quote of the week
From the signed CEO letter supporting Fuller stocktake: ‘A golden thread ties this report together: integrated neighbourhood teams. We need a stronger platform for service delivery and improvement in every neighbourhood. While we accept that the maturity of PCNs varies across the country, we see brilliant examples of PCNs that are bringing together a wide range of services as part of a much broader version of general practice, through deep partnerships, as integrated neighbourhood teams managing the health of their population’.
Read the full Fuller Stocktake Report here.