Primary care and Implementing the Long-Term Plan

11 July 2019

David Segal, Manager

The Long-Term Plan is arguably the biggest set of changes since the Lansley reforms.

The Westminster Health Forum Keynote Seminar: Primary care in England and Implementing the NHS Long Term Plan was an opportunity to investigate what the Long-Term Plan means for primary care.

Opening the day Raj Patel MBE (Deputy Medical Director of Primary Care, NHSE) recognised both the ever-growing pressures on primary care, and important recent changes, focussing on the introduction of Primary Care Networks (PCNs).

It was clear that successful PCNs will depend, not on watertight theory, but on how they are implemented and on system support.

Here is my take on the key factors identified by the seminar that are needed to implement a successful PCN:

1. Over-analysing the ‘30,000 – 50,000’ population figure is a waste of energy. The evidence shows us that collaboration at a scale in this ball park allows systems to deliver practical and sustainable personalisation. Some PCNs may operate on larger scales (e.g. 100,000 – 120,000) to avoid unpicking existing collaboration. These changes are not aimed at achieving efficiency or uniformity due to this ‘magic number’. They are instead intended to enable collaboration in a system delivering care that is tailored to the local population’s needs.

2. We must think wider than GPs. Currently GPs lead much of PCN thought leadership. There is therefore a danger that PCNs are viewed as purely General Practice collaborations. This would be a mistake as the opportunity to deliver holistic personalised care around a population must include all relevant services and community assets. This vision was clearly articulated by Steve Holland from the Norfolk and Waverley STP, where they are already building Primary Care Networks supported by a broad set of health, care and wider wellbeing services.

3. We must make it as easy as possible for PCNs to access enablers so they can concentrate on delivering outcomes. Issues were raised around the lack of solutions for legal advice, data sharing and technology solutions. All of these will require significant work to implement. Enablers may therefore distract focus and resources away from outcomes. We should support PCNs through national or regional (STP/ICS) solutions to give PCNs the time to reshape how they deliver care.

4. PCNs must take advantage of a wider range of staff. A PCN team should be able to react to its population’s needs in a dynamic way. Some staff are pre-defined in the primary care contract, but some speakers considered the benefits of a different staff mix. Equally, many speakers recalled national staffing challenges and highlighted the need to make PCNs a positive place to work.

5. PCNs must integrate with the wider health and care system, and have the ability to capitalise on the strengths and assets held within its communities. Many PCNs are drawing a line around their practices and primary care, looking inwards not outwards. However, PCNs will only be successful if they fit within the broader model of care. They must also borrow and lean on broader system resource that can’t be provided at PCN level for every PCN.

Although PCNS are complicated to develop and will have complex interactions within and outside of the health service I was encouraged by the positivity in the room about the potential for developing holistic population health solutions at a level that works for people. What do you see as the challenge and opportunities in your area?

To get in touch to hear about some of the work we are doing with PCNs across England or to discuss opportunities in your area please contact