Engaging and inspiring primary care – without understanding how to do this, we can kiss goodbye to population health management

One of the points of differentiation among the Integrated Care Systems (ICS) we work with is their ability to engage primary care, and, in particular, General Practice (GP), in the design and delivery of new health and care systems. This might be the most important factor in whether they will be able to deliver any real progress against the triple aim of better health, better care and better value for money.

The UK has the world’s most comprehensive and systematic coverage of its population due to its single registered GP list approach. This should provide the basis for an effective approach to population health management, especially when coupled with our local authorities having a statutory duty for the health of their populations. Yet too often we have ICS and Integrated Care Partnerships (ICP) designed and dominated, at least in their early days, by other NHS organisations. These have an episodic relationship with patients which often shapes their mindsets about new forms of integrated care working.

Why does primary care engagement matter?

Without ICS and ICPs establishing a population health approach, we will be trying to tackle the excessive and growing demand for our services with supply side growth and traditional thinking (even accepting that we might digitalise some of the routes to access care). This is neither affordable nor feasible in the medium to long term, both on financial and human resource grounds.

So how can we ensure that we have primary care and general practice effectively engaged and inspired?

We should start by recognising that the recent move to create Primary Care Networks (PCN) is very helpful if they are engaged sensibly. This requires an acknowledgement that PCNs are creatures of the General Medical Services (GMS) contract and not a line-managed entity of a local group. Their funding comes from a national negotiated pot and any attempt to expand their roles will need additional local resource. Most PCNs, in our experience, want to be part of place-based working but they can only do so if we recognise the terms of engagement that they and their constituent practices need.

We suggest the following terms are necessary:

1. equal partners – primary care must be treated as equal partners when engaged alongside colleagues from larger NHS organisations and local authorities;
2. upside benefit but downside protection financially – PCNs and their constituent practices cannot share financial risk with large trusts who get covered by the national system. They are small businesses that need protection against loss of income, but we can also incentivise them if they are able through population health management approaches to bend the pattern of utilisation, reduce costs and improve outcomes;
3. funding to participate – almost everyone sat round partnership board tables are paid to be there, but GPs are not so we have to fund their engagement appropriately;
4. payment for additional services – we have to invest in the capacity to deliver services out of hospital;
5. competency-based selection of primary care representation into the different management tiers and boards – when primary care representatives are engaged, they need to be able to act as a key player in a bigger system while also recognising the interests of the sector. These are tough judgments to make and there are not enough non-exec skilled and experienced individuals to undertake those roles. Competency-based selection rather than purely democratic selection can help with that and identify ongoing training needs.

If we want the new ICSs to be successful, they should reflect on whether this approach can create the effective engagement of primary care they need to be successful.

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