Views from the frontline: give primary care the freedom to transform

11 October 2016

“… it was the age of wisdom, it was the age of foolishness…it was the season of darkness, it was the spring of hope, we had everything before us, we had nothing before us…”

Dickens’ words define my every working day. These are challenging times.

If properly resourced, in ten years’ time, strategic game-changing decisions that I am taking today will have paid off and will be yielding dividends. If not properly resourced, like other ‘transformational reforms’ of the NHS in recent years, they will have been forgotten, having proved vainglorious, unworkable and largely useless. And I will be gone.

We know the problem: money is spent on reactive care in hospitals. But there is another.

Policymakers regard the NHS as a single entity. This is wrong because it is too unwieldly; too unresponsive; and too difficult to manage in that guise. Generations of policymakers have fallen into the same trap – policy frameworks to set standards quickly become mandatory, operational ‘how-to’ manuals applied universally. The NHS is an industry made up of many organisations that need treating differently.

Right now an attempt to acknowledge difference and encourage creativity appears to be reverting to something more controlling. A small number of Vanguard organisations (mine included) were singled out and offered greatness last year. Some got significant additional funding; some didn’t (mine again). Thus far Vanguards haven’t delivered the savings/improvements quickly enough to satisfy policymakers and politicians.

As a result, Vanguards are morphing into ‘Sustainability and Transformation Plans’ (STPs). STPs come with instruction, are led by centrally appointed chairs, have reporting templates and ‘regular check-ins’ with officials. The NHS is comfortable working like this. STPs are already being hailed as the latest version of Strategic Health Authorities. This is not necessarily a bad thing, but it’s not letting flowers bloom.

There are 909 working days until the next election. STPs aim to help address the £22 billion shortfall in funding the NHS is anticipated to face in 2020. Deduct say £500 million in proven ‘efficiencies’ and we have a £21.5 billion problem remaining. Put another way: £23.7 million in ‘efficiencies’ to be found every day between now and May 2020.
In three words: not a hope.

By centralising control (grip), we lose creativity, local ownership and thus the drive to transform ourselves into something leaner and better positioned to succeed. I don’t want to be controlled, I want to be supported to excel. That support is evidenced by giving me room to manoeuvre and sufficient resource to broaden and deepen our services.

We are currently the largest ‘true’ partnership in the NHS and are growing. We have 115,000 registered patients – a figure set to reach 300,000 within 18 months. We have 60 partners; we operate from multiple sites offering a variety of specialist services; we are in three STPs.

I want us to assume full responsibility for the healthcare needs of our patients. We will take financial risk as part of this. I am happy to deliver against outcome standards – clinical and financial.

We are not a hospital chain owned by the state. We are primary-care clinics owned by general partners. We see the NHS through clinical and commercial eyes. Every decision we take has to deliver something better for patients, taxpayers and us. If one of those objectives isn’t met, then the implementation test is failed.

If we are to transform the NHS, primary care needs to be treated differently and taken seriously. Only by broadening and deepening and supporting primary care by giving us budgets can we make the necessary changes.

Professor Robert Harris is General Partner of Lakeside Healthcare



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