The Fuller Stocktake has, for the past few weeks, been a hot topic of conversation across health and care.
Commissioned by NHS Chief Executive Amanda Pritchard and endorsed by all 42 Integrated Care System (ICS) Chief Executives in England, the Stocktake focuses on next steps for integrating primary care: understanding what is working well and how this can be supported and scaled, whether that’s the role of general practice, community pharmacy, dentistry, optometry, audiology, or the wider health and care system.
In her findings and recommendations, GP and ICS Chief Executive Dr Claire Fuller has gone beyond traditional definitions of primary care to bring together a broad range of views around the future of local health and care delivery, and how this will need to evolve to respond to the challenges ahead: including addressing health inequality, managing workforce and financial pressures, and ensuring people care access the care they need, where and when they need it.
A key success of the Stocktake has been bringing together lessons learnt over the past decade and beyond, with a shared ambition to go further and faster.
In that sense, Claire Fuller has created a powerful shared moment in the journey of transforming health and care. For all of us, the key question is how best to take advantage of that moment to ensure it isn’t lost amidst the very operational pressures that catalysed the need for the Stocktake in the first place.
Often, implementation is where the really radical work happens, which is what makes it so hard and so uncomfortable. Building on our experience, including of working with Claire in Surrey since 2015, we have set out some initial thoughts about how to start that process of further change, how to develop the necessary conversations, and how to manage that discomfort positively – using the Stocktake to create the vision of the future that it describes.
Firstly, we suggest that the Stocktake is not about radical “blue-sky” thinking.
Rather, it is a frame for understanding how to structure and prioritise existing plans and activity in the home, at neighbourhood, place and system level, in the context of what has been shown to work – including in relation to prevention, complex personalised care, and better integrated urgent care.
Critically, this cannot be about adding to already un-achievable lists of things to do, whether those lists belong to individual GPs, Primary Care Networks, Places or System Leaders.
It must be about ensuring that tomorrow really is coming to the aid of today.
So, step one is to work out what has already been achieved.
This means understanding where local individuals, communities, clinicians and professionals are already working differently and where as “systems of systems” we each are on the journey. It means understanding how, through working differently, the process of bringing resources together will continue to make the lives of ordinary people and the frontline professionals who support them better and easier.
Which brings us to the second point – no one is starting from zero, but we are not all starting in the same place.
Starting from where we are, working out what assets we already have as a system, as places and communities; what health, local authority and VCSE partners each need and each bring; what are the enablers we have to prioritise; and, in this context, what we can do tomorrow vs. what needs to be part of our longer-term plans – this is all part of the process of building shared self-awareness as a gateway to successful implementation.
We can’t build on sand, so an honest assessment of where local strengths and weaknesses lie is not just a “nice-to-have” but provides the foundations to align and ground people in where we need to go next.
Last but by no means least, this continues to be about people.
Change succeeds to the degree that people are able and willing to change how they behave. Behave as though we are already living in the world we want to build and we will build it a lot faster.
This is not as easy as it sounds; in fact, it is the hardest thing because it always requires someone to go “first”; but, without changed behaviours, the best ideas remain just that.
If we believe integrated neighbourhood teams will be able to better respond to the needs of individuals and communities, we need to start by coming together and talking about how we will work as part of that team. It takes time to co-develop a model that works for everyone, but that is time well spent. The later we start, the more time it will take.
The first step is always the hardest to take.
There is always an argument for asking what is stopping us from trying things out that are designed to make life easier and to resolve otherwise intractable challenges facing our health and care systems, including around finances and workforce.
The Fuller Stocktake includes a list of actions that government needs to take to enable primary care to be more sustainable in the future, but we know we cannot simply wait for future, external interventions in systems and places where the status quo is breaking today.
In the end, and above all, we need to start.
The Stocktake provides a shared moment where we are all talking about the same thing. That moment will pass, as winter draws in, but we have an opportunity to make its impact last by accepting the challenges it presents, accepting that it is a starting point rather than a finished product, and by using it as a tool to work together more effectively and in a way that recognises and responds to the realities facing us all.
The latest version of our free Fuller Stocktake resource pack is available to download for free.
The full “Next steps for integrating primary care: Fuller Stocktake report” is available to download here.