Welcome, friends and colleagues, to this year’s NHS Alliance conference. Our first ever Action Summit.
This is one of our most important gatherings ever, taking place at a time of unique challenge but also a time of unique opportunity.
We are approaching the end of what has been for many in primary care – GPs, practice nurses and managers, and colleagues in pharmacy, optometry and beyond – a long, exhausting and sometimes demoralising year.
Remember though, this was also a year in which the NHS was recognised by the Commonwealth Fund as the best healthcare system in the developed world. An international panel of experts rated its care superior in terms of quality, access and efficiency to countries which spend far more on health.
”The NHS is and remains one of the proudest achievements of our modern society.
It was founded in 1948 in place of fear – the fear that many people had of being unable to afford medical treatment for themselves and their families. And it was founded in a spirit of optimism – at a time of great uncertainty, coming shortly after the sacrifices of war.”
Simon Stevens’ opening words in the Five Year Forward View provide us with the opportunity to revive that same optimism as the NHS spotlight moves from hospital care to an integrated care system, predicated on the GP registered list. Optimism that many of you will have felt from hearing him just now. Optimism that was given a further huge shot in the arm yesterday with the Chancellor’s proposals for financially supporting the development of primary care. Some tribute to the persuasive abilities of our Secretary of State for Health, who will be giving us some detail on these proposals at this Summit later today.
So today I have three clear messages.
- We must now focus on inspiration for the future, not dwell on the past.
- No more heroes, no more heroics – as GPs we must now recognise that it’s not all up to us and that it’s no longer all about us. It’s time to let go.
- 3. It’s not all about the money. Some of it is about the money but it is also about doing things differently, doing things better.
First though let me our articulate our vision for today’s NHS Alliance.
The NHS Alliance has always aimed to put outcomes and know how ahead of self-interest and know who. We have become first and foremost a social movement, by virtue of a solid heritage of delivery, strong values, a common purpose and inclusive foundations meaning that we connect with professionals right across the front line: from health care assistant to district nurse, GP partner to pharmacist, GP commissioner to practice manager to housing professional, we all have a day job. That is our strength.
Our endurance is testament to your collective commitment to think ahead of the curve. Our major think pieces Breaking Boundaries published early in 2013 and this year’s Think Big, Act Now are sign posts to this year’s Forward View.
And we remain strong. Today, we are more than 9,000 passionate and committed professionals and organisations right across the primary care spectrum, and increasingly from housing, urgent care and the emergency services. Indeed among our most recent new members are the Chief Fire Officers’ Association, Riverside Housing Association and all the GP practices within Heywood, Middleton and Rochdale CCG – I believe all are here today so a very warm welcome.
We are a force for the future. A force, as so many Secretaries of State have said, “to be reckoned with”. What unites us is a burning desire to learn from each other so that we can make the system and our services better for the NHS, better for those working within it and better for patients.
We have restlessly argued the case for primary care and for us all coming together outside our professional and organisational tribes. This makes us one of the most relevant representative organisations in health today.
Nelson Mandela famously reflected that action without vision is only passing time, vision without action is merely day dreaming, but vision with action can change the world.
The NHS may not quite be the world but it is our world. And we must combine vision with action now to safeguard a national health service free at the point of need for our children and our children’s children.
But, to sustain it we need to translate thinking to doing. Simon Stevens’ view is strong, reassuring and pragmatic but it is still – and he has been consistently clear about this – only a view… and a view from the quarterdeck at that.
The NHS has not always been so good at implementation which means it is now up to us – the people and organisations delivering and influencing care and services on the primary care front line to translate that view in to an achievable plan.
That may feel like a bridge too far in these difficult days but these are times of opportunity. As a frontline clinician of course I share your despair over escalating bureaucracy and workload. We all face the fear and worry about dwindling budgets and dire problems with workforce. The health challenges are all too obvious – obesity, smoking, dementia and an ageing population with long term conditions. Only last week I visited a 103 year old followed by a 104 year old, both living on their own. The following day my first visit was a 93 year old who was also living on his own.
But there is a way forward. And it involves us all.
First we must learn once again to allow all our professionals to be professionals. Not zombies. Not chickens dancing to the latest target or financial incentive. Then we need to train a sufficient primary care workforce to meet the opportunities for extended primary care. The Secretary of State is quite right to say we need 50% of doctors to become GPs but it won’t happen unless we revolutionise a flawed system that currently gives training doctors minimum exposure to primary care and then channels all the funding for primary care education through hospitals and then channels it through secondary care dominated medical schools. If we want the money to go in to GP training then it must be earmarked centrally for GP training. Ditto for practice nurses, community nurses and the many new professionals that will all be required to get things moving at scale and at speed.
Then general practice, with its registered list, must start to work in a different way and connect with colleagues across primary care and beyond: with other practices, with community nurses and allied professionals, with local pharmacy, with local providers of eye and hearing care, with colleagues in housing, urgent care and the emergency services, with social services, voluntary services and individual volunteers. Indeed, with us all as patients and with the broader community we can then create that Community of Care we described in Think Big.
Which takes us to my second message – no more heroes. If we don’t want to see our own Rome burn we must stop being heroes and heroines.
General practice is at a tipping point. It’s time to let go. Working 12, 13, 14 hour days is not heroic. It threatens our ability to provide safe and consistent patient care; it affects our family lives; it affects morale and job satisfaction. We became clinicians in order to provide care, to diagnose and heal – not to push paper around late into the night.
I’ll talk later about our work to reduce bureaucracy but engaging with government, policy makers and commissioners – which includes many of the clinicians here today – is not enough. As providers, we must be part of the solution too.
As GPs, we have to accept it is not all about us. It is about a much bigger picture. We need to work with others to stay well ourselves. We need to put silos and fragmentation behind us. We need to look forward but without losing those traditional values of family medicine and locally-based health services. Values that deliver personal care and continuity and build on the assets of the communities in which people live and work.
Because healthcare in the future will look and feel different. It won’t divide neatly into primary and secondary care. It will become part of a wider system, one where the edges blur and dissolve. One in which we must all play our part as responsive and responsible citizens.
That means we must be open to reaching out beyond our own front doors and creating partnerships and working relationships across our communities.
That new approach to healthcare is already with us, the Forward View’s Multispecialty Community Provider. We described this in Think Big as a Community of Care – a model based on the registered list, with general practice at scale at its heart and an extended primary care team incorporating community services, pharmacy, eye and hearing care, housing and urgent care radiating out from it.
These extended players must not be understudies or handmaidens waiting in the wings but an integral part of a specialist health team playing a full role in managing ill health and, most importantly, helping to manage demand and defeat the causes of ill health.
For instance, we have already seen community pharmacy grow in stature this year through its Dispensing Health campaign, highlighting the important role it can play in helping manage public health and we support this ongoing work.
NHS England describes a scenario where such a multispecialty community provider might also employ hospital consultants, have admitting rights to hospitals – even running community hospitals and take delegated control of the NHS budget.
In Breaking Boundaries we articulated a vision of secondary care liberated from the boundaries of the hospital. NHS England also makes the case for an integrated hospital and primary care provider, Primary and Acute Care Systems which combines for the first time general practice and hospital services acting as equals, similar to the Accountable Care Organisations now developing in other countries.
This is a concept we have been exploring this year in collaboration with our strategic partner NHS Providers (formerly the Foundation Trust Network) and we will be jointly publishing a ‘ can do piece’ in 2015.
What really does matter is that innovation at the frontline should start with a level playing field especially in primary care where lack of surpluses, resources, expertise, capital and critical mass could make us prey to bigger players.
To play our part in this we set up our New Providers network last year to provide practical support, shared learning and peer-to-peer help for new models of care including federating practices. That is because it is increasingly recognised that real innovation will often be driven by providers, and this network provides an important home for sharing and driving that innovation.
And to show how newer models are working in action, we’re privileged to have two inspirational doctors – Jonathan Serjeant and Amanda Doyle – with us today, who will share their respective experiences of multispecialty community provider and primary and acute care models in Brighton & Hove and Blackpool later. They show how much can be achieved in “Can Do” mode.
But “Can Do” must go way beyond our traditional ideas on care. If a patient presents with a social problem, as they often do, then let’s not try and sort it out with pills. We must be able to offer something different like a facilitated social prescription. When a frail elderly patient or one with complex disease needs co-ordinated treatment then let’s make sure there is someone to co-ordinate their care – a senior district nurse or care organiser.
“Can do” must then go upstream and realise the power of primary care and the registered GP list to improve the health of local patients and people. This was the message of our Community Development Charter for Health launched in the House of Commons this summer. Led by Brian Fisher it showed that investing in community development has a social return on investment of £15 for every £1 spent. Extended primary care must now see itself as a crucial player in the development of health creating communities. Nothing less than an agent for social regeneration. Our idea of Community Health Connectors will help us to achieve locally those health ambitions behind establishing Health and Wellbeing Boards. Ambitious we must always be. As Robert Browning reminds us,” our reach should exceed our grasp – otherwise what is heaven for?”
And if we achieve all these things then perhaps we could reduce those billion prescriptions a year. Avoid NICE’s predicted one million or is it now 2 million gastric bypasses ? Avoid having to put most of our population on statins.
My second message was No More Heroes, my third is that’s it not ALL about the money.
Of course, in times of such financial restraint, it’s impossible to ignore the money and one of our clearly stated aims is to ensure Simon Stevens’ pledge to invest in primary care translates to at least a two and a half per cent uplift, taking us back to the ten per cent slice of overall NHS budget allocated a decade ago.
And as the whole service dissolves into a more integrated system, we will push even harder to achieve a single payment structure, eradicating the capitated versus activity models currently in operation in primary and secondary care respectively.
Finally, having campaigned for a Development Fund to be made available in every CCG locality, we will now ensure that there is sufficient within recent announcements of a Transformation Fund to support providers with the expertise and resource they need to make Communities of Care a reality. And if that also means melting down clinical senates, NHSIQ and the Leadership Academy to release the money then,quite frankly,so much the better.
But it’s not all about the money.
In a recent poll of our members, it was clear that unprecedented levels of bureaucracy have created an almost unbearable workload. You simply want time back to do what you trained long and hard to do.
Good intentions are too often translated into bureaucratic nonsense, which puts in financial incentives and targets that demean professionals and do nothing for patients. Payments, for instance, to diagnose dementia rather than doing anything about it. Payments for producing highly specified care plans for our frail elderly rather than actually caring for them.
The combined effect of bureaucratic and financial pressures is beginning to create a divide between what frontline clinicians feel able to deliver and what patients have been led to expect. A fracture so serious that unless we act quickly we could see the unravelling of the NHS from bottom upwards. I believe that in the past few days that ever present danger has been recognised and is now being acted upon.
To do our bit NHS Alliance Catalyst, our new delivery arm, is currently undertaking a number of projects, including two on reducing bureaucracy and pressure in general practice for NHS England. Catalyst is proving to be a modern and cost -effective alternative to traditional management consultancies, delivered by the people who still work at the frontline and who understand it.
So this is not about income. It is about doing things differently, creating a new sense of purpose and mission. It’s about inspiring a new generation of GPs, practice nurses, and community nurses, community pharmacists, optometrists and the many other unsung health professionals who support millions of patients every day.
Somewhere between policy and implementation the caring, the compassion, the commitment and the going the last mile too often gets squeezed out . Pay someone to go a mile and they will only go a mile. Encourage, support and inspire them to go as far as they can – and for the same money – they will go ten.
Our Tomorrow’s Leaders network launched by the Secretary of State for Health has a clear remit to shine a light and inspire the next generation of GPs, practice nurses, practice managers and community health specialists. We will launch our “Inspiration Campaign” in early 2015.
I am especially pleased we were able to provide bursaries for 20 young medical students to attend today, all still in the early stages of their careers. We look forward to your blogs on the NHS and what might attract you to a career in general practice in the future.
And I’m delighted that one of tomorrow’s leaders, Dharini Shanmugabavan joins David Jenner in discussion with four leading think tanks immediately after this.
They will provide a strong start to a strong programme. I would also like to thank our tireless and passionate executive team, who do so much for very little financial return but are instrumental in effecting tangible and long-lasting positive change.
All active on the front line, they have shaped and are delivering today’s inspirational specialist streams. From managing mental health in the community, general practice at scale, pharmacy and communities as assets, co-commissioning and housing as a determinant of health, these are hands-on, practical sessions designed to translate thinking to doing.
And before a brief conclusion, some thanks and acknowledgments. To our strategic partners, Capita and Novo Nordisk, with whom we have worked closely throughout this year to better understand the new models of care from a process and medicines perspective, thank you. You are valued partners, whose skills, expertise and knowledge have enhanced our own insight and whose financial contributions enable us to maintain our inclusive membership fees.
As you know, today’s Summit is all about action. But that does not mean we should stop thinking. 2015 marks the launch of a pair NHS Alliance events – a June think summit twinned with a December action summit. If you would like to be on the priority invitation list for either summit, do visit our stand outside and let our team know.
So to conclude.
Doing nothing and harking back to a golden age is not an option, we must now look forward and inspire. Inspire our colleagues and inspire those who might want to train and join us to improve health and care in our communities.
No more GP heroes and heroines. We can’t do it all. The world is different now. We don’t need new structures and new barriers. We need new relationships. We need to work with colleagues across both primary and secondary care and more than ever with our patients. From now on we must see our patients and our communities as our greatest asset. Our greatest hidden secret. Times are changing and the boundaries are blurring.
And finally, it’s not all about the money. Yes, there are inequities in the system. Yes we are working to address those. Yes, there should be dedicated funds to develop primary care. But is it all about the money? No, it is not.
A love for what you do, time to deliver both care and compassion, time to listen, time to be kind, time to discover a new relationship with your patients. These are what matter most, what have always mattered most and which will continue to matter most in the kind of NHS that we will create. An NHS of which we and our patients and our communities can then continue to be proud.
