Primary care at system level

Primary care leadership within systems is a hot topic right now. The introduction of integrated care systems can provide a real opportunity for primary care to have a voice at system level and build stronger relationships with health and care partners within a local area. However, given the complexity of the provider landscape, this shift to system working can also prove challenging as primary care leaders navigate building a strong collective voice for primary care.

As the value of primary care at system level becomes clearer, the appetite to develop formalised structures is growing

We are beginning to see different models of primary care collaboratives developing at system level. While many have come together through necessity, emerging during the COVID-19 pandemic and vaccination programme, a significant number are growing and maturing because of the dedication across primary care providers to be truly integrated, become leading partners in integrated care systems and ensure the best outcomes for the populations they serve.

The value of primary care at systems level

Formalised primary care structures at system level have a number of benefits for providers, systems and most importantly, patients:

• a collective voice for primary care at system level
• primary care can benefit from economies of scale and reduce duplication
• primary care can bid for contracts at system level
• accountability at all levels from practice to system decision-making
• greater opportunities to work with system partners
• opportunities to bring together other parts of primary care including community pharmacists, dentistry and optometry.

As the value of primary care at system level becomes clearer, the appetite to develop formalised structures is growing. For many, the biggest question when trying to develop these structures is: where do you start?

How do we do it?

In reality, there is no blueprint for developing primary care leadership at system level and while this has its practical challenges, it is vital if structures are going to reflect local need. There is no one-size-fits-all model. Primary care providers can utilise existing local relationships and build accountability and representation from the ground up.

"This doesn’t happen overnight, it takes time and there are competing priorities and challenges" 

As Mariam Ganesaratnam, chief executive of Merton Health and new chief executive of the South West London Primary Care Provider Alliance put it in our recent Q&A with her:

“It took us (SWL Primary Care Provider Alliance) over 18 months to develop a structure and voice at system level. This started with informal conversations and meetings as a group of federations in our own time. We felt there were real benefits in simply sharing learning, challenges, successes and priorities from our local boroughs. Then we began to think how we want primary care to look in two or five years’ time… But this doesn’t happen overnight, it takes time and there are competing priorities and challenges”

Taking the first step to developing primary care leadership at system can be daunting but what is essential to the success of any collaboration is strong, trusted relationships across primary care providers. The time it takes to build on existing relationships and develop new relationships should not be underestimated. Federations are well placed as connectors in the primary care system to bring providers together at place. As membership organisations, federations are able to bring together practices and primary care networks and ensure accountability from the coalface of care delivery to system level. They also have years of experience delivering at-scale primary care services, working with system partners and upskilling primary care leaders. This means they already have many of the tools to help build system leadership structures.

Independence at system level

The independence of primary care providers can make it challenging to develop primary care structures at system level. Despite greater collaboration across primary care providers, they still need to be able to compete for contracts and services, where appropriate. As collaborations develop, it is important to ensure services are delivered at the right level for patients, and providers are able to maintain their own independence and stability.

In South West London, primary care providers used Hill Dickinson as an external facilitator to help navigate through some of these complexities. Through several workshops they developed a set of guiding principles which protected the freedom of primary care providers and ensured the alliance supported providers and structures which were already working well.

However, what works for one system may not work for another and as we see more models for primary care at system level, we will also see more challenges and opportunities come to light. Through NHS Confederation, we will continue to share learning and models for primary care at system level.

You can learn more about the South West London model in our Q&A with Mariam Ganesaratnam on the Primary Care Hub.

Charlotte Wilson is policy and delivery manager at the NHS Confederation. Follow the organisation on Twitter @NHSConfed