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National Health Service History
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Primary and community care services are regarded with pride at home and admiration abroad. Thanks to the dedication of family doctors, community nurses, health visitors, allied health professionals, social care professionals, pharmacists, dentists and opticians, most patients enjoy good quality care, close to home. There are high levels of satisfaction with services and trust in the staff who provide them.
We need to ensure that high-quality care is a consistent part of everyone’s experience of primary and community care. Services need to evolve to reflect the changes in healthcare and society described in ’Our NHS, Our Future’: rising expectations, the ‘information age’, advances in treatments, the changing nature of disease and the evolving nature of the workplace.
The vision and strategy in this document have informed, and been informed by, the wider NHS Next Stage Review. We and our Advisory Board have discussed extensively with members of the public, with clinicians across the NHS including many involved in the regional reviews, and with colleagues from local government and other sectors how together we can raise and realise our ambitions for primary and community care.
Our conclusions fall into four broad themes:
People shaping services
1. We will promote personal and responsive services that systematically listen to and act on patient views. We are developing the GP patient survey to give patients a greater say in whether practices are providing not just fast, convenient access but an all-round quality patient experience (paras 4.1- 4.7).
2. We will help GPs work with community health teams, pharmacies, social care, schools and other groups to give patients access to a greater range of services in their local communities that fit around their needs (paras 4.8-4.14).
3. Patients will have greater choice of GP practice and better information to help them choose. We will develop a fairer funding system, giving better rewards for GPs who provide responsive, accessible and high-quality services (paras 4.15-4.18).
4. NHS Choices will provide greater information about all primary and community care services, so that the public can make informed choices (paras 4.19-4.22).
5. By 2010, some 15 million people with long-term conditions will be offered their own personalised care plan. Named lead professionals will help ensure that plans and services are tailored to support the needs of those with the most complex care needs (paras 4.23-4.27).
6. We will publish a Patients’ Prospectus to provide excellent advice for those wanting to take greater control of how they manage their long-term conditions (paras 4.28-4.29).
7. Learning from social care, and working with patient groups, we will pilot individual budgets to help people have greater control of their health and care (para 4.30).
Promoting healthy lives
1. The NHS will work with local government, the third sector and independent sector to promote health and wellbeing in local communities, with greater pooling of resources. We will develop a suite of indicators that Primary Care Trusts (PCTs), local authorities and practice based commissioning groups can use to measure and incentivise improvements in health and wellbeing (paras 5.2-5.4).
2. Primary and community care services will support people in staying healthy throughout their lives, from the pivotal role of health visitors in the new Child Health Promotion Programme to that of community nurses in helping older people keep healthy and independent (paras 5.5-5.12).
3. We will support people to stay healthy at work and return to work more quickly, piloting integrated access to musculoskeletal, psychological and other services (para 5.9).
4. We will work with GPs, pharmacies and other services to introduce a vascular risk assessment programme for those aged 40 to 74 (para 5.10).
5. We will improve access to a range of healthy living services to help people give up smoking, control alcohol use and improve diet or exercise (paras 5.13-5.15).
6. We will ensure that primary and community care services have a central role in tackling health inequalities (paras 5.16-5.20)
7. We will work with professional and patient groups to improve the world-leading Quality and Outcomes Framework to provide better incentives for maintaining good health as well as good care (para 5.21).
Continuously improving quality
1. As part of our overall strategy for quality outlined in ‘High Quality Care For All’, we will introduce a programme of professional development to strengthen clinical leadership and skills for community nurses, health visitors and allied health professionals and release more time for direct patient care (paras 6.3-6.7).
2. We will pilot information tools to compare clinical quality, clinical productivity and patient experience in community health services. We will develop new tariffs to improve the commissioning and delivery of services and encourage more healthcare to be provided in community settings (paras 6.8-6.9)
3. We will support the NHS in making local decisions on the governance and organisational models that best underpin vibrant, high-quality community services. Staff will have the right to request setting up social enterprises. Staff who transfer to new social enterprise organisations will continue to benefit from the NHS Pension Scheme (para 6.10-6.11).
4. We will work with professional and patient groups and with NICE to create an independent, transparent process for developing and reviewing the indicators in the Quality and Outcomes Framework, reduce the number of process indicators and focus resources on health outcomes and quality (paras 6.13-6.14).
5. We will support the NHS in collecting, analysing and publishing data on service quality to recognise and reward excellence and support patient choice (paras 6.15-6.18)
6. We will promote accreditation schemes to improve quality and identify best practice, including working with the Royal College of General Practitioners to drive forward accreditation of GP practices (para 6.19).
7. The new Care Quality Commission will, subject to consultation, register all GP and dental services and help tackle persistently poor performance whilst assuring standards for all (paras 6.20-21).
Leading local change
1. We will support PCTs and clinicians in making local decisions on how best to develop more integrated primary and community care services (paras 7.3-7.8).
2. Practice based commissioning (PBC) is central to our ambitions for health improvement and high-quality care. PBC groups will be entitled to improved information and management and financial support, for which PCTs will be held to account through the world class commissioning assurance system (paras 7.9-7.11).
3. PCTs, as the local leaders of the NHS and strategic commissioners of health and healthcare for their population, will give increasing power and responsibility to high-performing, multi-professional PBC groups that achieve better health outcomes for local patients in a transparent and accountable way (paras 7.12-7.13).
4. With the support of PCTs, we will pilot new ways of allowing primary, community and hospital clinicians and social care organisations to provide more integrated services for patients, including the formation of new integrated care organisations (paras 7.14-7.16).
5. With the NHS, we will provide support and development programmes which enable primary and community services to be better commissioned, securing improvements for patients and taxpayers alike (paras 7.17-7.23).
6. We will establish a Minister-led group to identify how best to support those organisations that wish to go further in integrating health and social care (paras 7.24-7.25)
Next steps
Our conclusions work with the grain of the NHS and we will now support the NHS, healthcare professionals, patient groups and local government, third sector and independent sector partners in developing local strategies for primary and community care that secure improved health and enhanced healthcare for the people and communities they serve.
We will establish a national clinical advisory group to review progress and will continue to work with national patient groups.
