We must hold our nerve: continuing the Fuller transformation journey

Reports like the Fuller stocktake are often met with scepticism - a report is published, its recommendations largely supported, and then it disappears into the background with minimal action taken, left on a shelf to gather dust until the next report is commissioned and someone asks ‘what ever happened with the [insert name] report?’

This is often about lack of ownership and realism about what can be achieved. Reports often lack clear, outcome-focused recommendations and feel out of touch with the real world. The Fuller stocktake is certainly not an example of this and no-one would argue with the vision it sets out.  

The recommendations were clear, practical and targeted. All 42 integrated care board chief executives signing a joint letter endorsing the report sent a powerful message of their commitment to the vision and its recommendations.

For many, the stocktake offered legitimacy for the work they were doing locally to build a new vision for integrated health and care

For many, the stocktake offered legitimacy for the work they were doing locally to build a new vision for integrated health and care. I recently spoke to one primary care network (PCN) clinical director who said ‘I was doing so much of this work quietly with partners I’d not worked with before outside of the NHS, I didn’t dare tell anyone in case I was told I was doing it the wrong way. Since the work we are doing to connect with local people was included as a case study in the [Fuller] report…it makes our lives so much easier.’

The Hewitt review published earlier this year has also helped in both of these respects. It not only aligns with the Fuller report but offers many of the mechanisms to make its success a reality, with greater local autonomy and accountability and resource shift to out-of-hospital.

At the NHS Confederation, we have been proud to support both the Fuller stocktake and the Hewitt review. We have engaged members across all of our networks to ensure their voices have been heard directly or indirectly. And over the last six months, we have been building design groups and communities of practice around the Fuller themes. We have created spaces for primary care leaders to come together to work with national and system leaders to share ideas and solutions. Today, our design groups and communities of practice continue to offer strategic spaces to tackle some of the nuts and bolts of progressing the vision.

The challenge to delivering this vision remains the same today as it was 12 months ago

So, despite there being consensus, commitment and willingness from system and primary care leaders, why have we not seen progress faster and more widespread? The challenge to delivering this vision remains the same today as it was 12 months ago: without adequate time and headspace (with some resource), leaders are finding it difficult to manage today’s priorities and challenges at the same time as creating a better future for their patients and their teams. The workforce pressures in primary care are increasing, fuelled by the widening gap in pay with Agenda for Change. The cost of living has meant significantly higher running costs, and there are increased concerns for general practice closures caused by unmanageable workload and rising demand.

The Primary Care Recovery Plan was a realistic diagnosis of the issues and an important step towards supporting primary care to address the challenge of demand for its services, but it’s no silver bullet and many core issues have still not been addressed.

What we certainly do not need are reforms to the structures that are beginning to flourish and make improvements

Despite a general election less than 18 months away, we need a period of stability. We may be in the final year of a five-year contract, but PCNs are barely two years old. What we certainly do not need are reforms to the structures that are beginning to flourish and make improvements. PCNs, and at-scale primary care more generally, are core to ICSs delivering improvements in population health. As Matthew Taylor said in his recent speech to the RSM, the most inspiring primary care leaders are not ones for waiting around for direction, they are entrepreneurs knitting together networks, services and bits of funding, focused always on working with others to improve the health and wellbeing of communities. This type of entrepreneurship is exemplified to its fullest by leaders like Dr Neil Modha at his family-run Thistlemoor Medical Practice. Dr Modha spoke to Matthew Taylor in a recent Health on the Line podcast about the work he is doing to bring the local community into the general practice workforce, create a learning organisation and integrate with other providers. We must harness and support these types of community leaders and assets, not impose restructures or new models on them.

The Fuller stocktake transformation journey is in motion. It may not be as quick as we would have hoped, but we must hold our nerve. This kind of cultural change takes time, and we need to be willing to have a different conversation about how we embed this shift to integrated, community-focused care through true collective responsibility, shifting power and money to where it has the most impact on individuals.

Charlotte Wilson is senior policy and delivery manager for the NHS Confederation’s Primary Care Network. You can follow Charlotte on Twitter @CharlotteSydney