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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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RedTapeOctober 22 2014

The NHS Alliance is calling for a reduction in bureaucracy and more collaborative working in primary care to ease GPs’ workload.

Its new strategy document, ‘Think Big, Act Now: creating a community of care’, proposes that general practice needs a system that “restores professionalism in its best sense rather than one that reduces clinicians to ticking boxes.” It wants to see community pharmacists extending their role by increasing their involvement in prescribing or by practices directly employing primary care pharmacists to reduce pressure on GPs.

The organisation, which represents health and social care providers from outside the hospital setting, also says GP core funding should include more of what is currently paid for under Quality Outcome Framework and Direct Enhanced Services contracts with less specification of how this will be delivered.

NHS Alliance has spent six months researching views from across primary care. Its document aims to create a “responsive and responsible service” and proposes a 10-point plan with five immediate steps:

•    to use community and district nurses, community pharmacists, community eye care and hearing specialists to help address the current deficit of GPs and share care across different professional sectors;
•    to reframe the role of Senior Community Nurse to co-ordinate health and social care for the frail and elderly living with long term conditions;
•    to introduce a new role in every locality: a ‘Community Health Connector’;
•    to reduce the medicalisation of issues that are often caused by social isolation or inadequate housing and introduce a new focus on social prescribing; and
•    to introduce a General Practice Development Fund to enable general practice to be supported to develop at scale.

Announcing the strategy document, NHS Alliance said: “Immediate action is needed to achieve the paradigm shift required to support a growing and ageing population living with myriad complex conditions.” It wants to see general practice sitting “at the centre of a cohesive primary care team of multi-disciplinary health professionals and community leaders, and working collaboratively with colleagues in the acute sector.”

Other proposals include:

•    there should be a significant uplift in funding to primary care – a return to its previous 10% of the NHS budget.
•    new technologies such as telehealth, electronic patient records and IT connectivity should be at the heart of general practice
•    the financial model for the NHS should encourage co-operation rather than competition between primary and secondary care.

Dr Michael Dixon, chairman, NHS Alliance said: “The perfect storm of pressures facing primary care makes it likely that change will come, whether or not it is wanted. We want to see change by design rather than default: change led by those working within the service who best understand the issues they and the communities around them face.

“We propose an incremental journey towards what we are calling ‘a community of care’, which is based on the implementation of general practice at scale but is not all about GPs. And while it may not be about the money in terms of GP income, we do believe financial support is required to support what needs to be a rapid transformation.

“This must come in two forms – one, a return to at least a 10% share for primary care of overall NHS budget to reflect the fact that more than 80% care is delivered outside hospital, and two, a dedicated General Practice Development Fund to allow immediate action to be taken.”

Links:

NHS Alliance statement

NHS Alliance report ‘Think big, act now’

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