Conservative Party conference: The NHS in transition – can community and primary care lead the shift?
Researcher
There has long been consensus among policymakers and the NHS alike that a leftwards shift is urgently needed in our health and care system, from sickness to prevention and from hospital to community. Yet after decades of pursuing these aims, meaningful progress remains elusive. This challenge set the context for Re:State’s private roundtable at Conservative Party Conference.
Kindly supported by Community Pharmacy England, we were delighted to be joined by Dr Luke Evans MP, Shadow Parliamentary Under Secretary for Health and Social Care, for this discussion.
For me, three key points stood out:
From consensus to delivery
The Government’s long-awaited 10 Year Plan was published in July, setting out a clear direction of travel for the NHS. Its aims enjoy broad cross-party and professional consensus, but attendees agreed the plan’s ‘delivery chapter’ is missing. Real barriers still prevent the shift of care and funds away from hospitals and into community.
It is now vital that focus shifts to how the plan’s aims will be delivered. The crucial role for Dr Evans, and the Conservative Party more broadly, is to hold the Government to account on this ‘how’, ensuring shared ambition is matched by well-executed delivery.
Integration won’t happen by accident
Greater integration – across different strands of primary care, and between primary care and the wider health and care system – is essential to achieving the leftwards shift, as is collaborative working. Yet this will not happen by default. Siloed funding flows, competition for the same pots of money, fragmented technology, cultural resistance to change, and unclear lines of legal accountability all make collaborative working difficult in practice.
These barriers must be overcome if the national vision for neighbourhood health and a shift to prevention is to be realised. Attendees, from across primary care, emphasised the need for significant cultural change, supported by contractual and funding reforms. National frameworks should actively reward and incentivise collaboration, while still allowing local flexibility to meet community needs.
Empowering community care
From community pharmacy, to high-street optometry and NHS dentistry, community providers of primary care are willing and able to take on more responsibilities for patients. These clinicians want to help people manage long-term conditions, support prevention, and reach vulnerable groups. These services are uniquely well-placed to do so – embedded in local communities and an accessible first port of call for those needing help, making them capable of helping to reduce health inequalities.
These community services are already operational, with the necessary expertise, to offer more. However, chronic underinvestment, fragmented commissioning from place to place, and unresolved questions about legal responsibilities when patients are referred on continue to limit these services. It is vital these barriers are tackled head on, enabling community care to fulfil its potential and lead in the next phase of the NHS.