Prescription for prevention: a new model of primary care
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In Reimagining Health: a framing paper, Re:State set out the case for a radical new approach to health, while Close enough to care set out a model of regional devolution of the health system.
This paper takes this work forward and argues for a new model of primary care. 90 per cent of daily NHS activity happens in general practice and the community. If the primary care model is no longer fit for purpose, it weakens the foundations of the entire system and undermines the longstanding ambition to move care into the community.
Prescription for Prevention sets out a new vision for primary care. Rather than simply calling for workforce growth or bigger GP appointment targets, it sets out a variety of interventions on estates, workforce composition, technology, regulation, and funding models. These are oriented around three core principles: to intervene earlier, respond faster, and avoid decline – all supported by a new technology and funding infrastructure (which are covered in two supplementary papers).
‘Intervening earlier’ focuses on the intersection between public health and general practice, and explores how primary care can intervene more effectively in the wider social determinants in a patient’s life. This includes Community Health Workers and an innovative regeneration of the primary care estate.
‘Responding faster’ is centred on relieving capacity in general practice. This will enable clinicians to react quickly to clinical need when and if it arises, in turn preventing illnesses from developing in severity. From AI-enabled triage, to a rescoping of general practice, to a more strategic use of the clinically expert nursing workforce, the reforms focus chiefly on increasing the responsiveness of the primary care system.
‘Avoiding decline’ seeks to elevate the critical role of the community services sector in the NHS. Long-term conditions continue to dominate healthcare use and expenditure, and community services — district nursing, specialist long-term condition nursing, community pharmacists, Health and Wellbeing Coaches, among many others — will be critical in meeting this demand. Individuals also need to be empowered to live with their conditions, and so tailored self management and tech-enabled remote monitoring will be essential.
This paper is published alongside two supplementary papers that explore the technology and funding reforms that would support the above interventions.