In May 2022, NHS England published the final report of the stocktake by Dr Claire Fuller, Chief Executive-designate Surrey Heartlands Integrated Care System and GP on integrated primary care, looking at what is working well, why it’s working well and how we can accelerate the implementation of integrated primary care (incorporating the current 4 pillars of general practice, community pharmacy, dentistry and optometry) across systems.

In our recent series on the recommendations identified in the Fuller Stocktake Report published on LinkedIn and Twitter, we shared our thoughts on data, population health management, leadership, personalised care and access. In the report, Fuller emphasises that crucial to the development of Integrated Care Systems (ICS) is creating the right environment that aligns to the needs of the local population. We share this optimism around the opportunities that the new health and social care reforms provide in transforming how primary care is delivered.

‍Data, Data, Data

Data was one of three environmental conditions discussed in the Fuller report alongside workforce and estates. Improvements to how we collect and use data is in our opinion a key ingredient for the NHS to be able to provide truly personalised and patient outcome-focused solutions, at neighbourhood and place level.  According to Dr Fuller, “Primary care must be at the heart of each of our new systems – all of which face different challenges and will require the freedom and support to find different solutions.” Indeed, if primary care is to be at the heart of each new Integrated Care System, then a clear and aligned, locally owned (end to end) data-driven approach is a necessity.

A patient centric population management approach supported by high quality data will drive new proactive models of care that improve health and wellbeing, reduce health inequalities, and identify interventions which could improve outcomes, and even reduce demand. Furthermore, overcoming barriers to enable data sharing across multiple organisations within systems could in turn be a lever toward shaping a transformative approach to improvement and collaboration.

‍Shifting the focus – integration and joining the dots

Empowering local leadership in the delivery of locally aligned care and facilitating integration are key conditions emphasised in the report.  A leadership that is brave, and one that fosters a culture of partnership working and embedded strategic and long-term thinking, with the headspace needed to do this, is a key enabler.  It’s also about recognising that a one-size-fits-all health and care system will struggle to meet the increasing complexity of people’s needs, and meet expectations around how those needs should be met. Whilst the report advocates supporting community partners to operationally embed relevant teams as part of existing PCN teams, how we orientate providers to neighbourhood is not yet quite clear and should be high on the agenda for leadership teams.

‍Right care, right place, right time

For Integrated Care Systems, galvanising a system approach to managing access to same day urgent care is paramount. This includes challenging the perception of current system provider remits and responsibilities to ensure that the right care is delivered in the right place, first time and indeed by the right healthcare professional. Of equal importance is the development of interventions and mechanisms to support elective recovery, and safe management of patient risk whilst waiting. For instance, without the well documented workforce challenges being properly addressed, managing access to same day urgent care is unlikely to be achieved. At the same time, the workforce challenge is one that will not be resolved in the short to medium term, and cannot be met within the local systems alone. Therefore, an integrated approach is not an option but a necessity to deliver right care at the right place, first time.

‍Digital enablers

Technology also plays a key role in ensuring that patients are seen in the right place, by the right healthcare professional at the right time, and provides the foundation for long term sustainability in health and social care. Interoperability between provider systems will enable joined up care, drive service improvement and innovation, and facilitate integration and personalised care. New technologies will support flexible, tailored services that support people’s health, wellbeing and promote independent healthy lives. During the course of the pandemic the use of digital tools and technology to manage long-term health conditions at home and to support independence increased significantly via interventions such as virtual wards, and outpatient video consultations. This momentum should be maintained and more informed alignment of digital technology to ensure consistency and interoperability in enabling system wide complimentary solutions will be key.

‍Vision to action

At Acumentice, we take a holistic and bespoke approach to working with our NHS clients, supporting them to create common goals, a shared purpose and build a collective vision. We are currently working with Integrated Care System clients to identify opportunities, challenges and priorities to inform a Primary Care Strategy refresh and to inform strategic direction. We also support multiple clients at all levels in approaching digital and data transformation to ensure they deliver current and future Population Health Management aims discussed in Fuller Report. For more information on how we can help your organisation https://acumentice.com/services/

We, at Acumentice, welcome this stocktake. With growing challenges in not just NHS hospital waiting times but also at GP surgeries, a report by Dr Claire Fuller on integrating primary care is useful and timely. It is an important and accessible guide on how to improve access, experience, and outcomes for communities by providing three essential offers: streamlined access to care, proactive and personalised care alongside helping people to stay well longer.