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The long-term plan is a pipedream without changes to asset ownership

As a GP and primary care network (PCN) clinical director in Sinfin – a deprived part of Derby City – I suspect my experience is one reflected across the country: many of the patients I see would better benefit from social or educational interventions along with (and in some cases rather than) a medical one.  We are living longer than ever before, but we are generally in poorer health[1] .  Added to this, the 2018/19 annual report by Derby’s director of public health highlighted that Derby has the widest inequality in life expectancy in the East Midlands[2].

The biggest health issues in Derby are those associated with education, lifestyle and social networks – obesity, hypertension, diabetes, back pain and depression. The answer to these issues in the vast majority of cases is not always a course of tablets or a hospital referral; empowering patients to make changes and manage their own long-term health conditions will lead to better outcomes in the longer term.

Indeed, the NHS Long-Term Plan acknowledges the same, and promotes as a solution multi-disciplinary support teams to address the needs associated with an increase of ‘lifestyle’ health conditions.  The formation of PCNs and the additional roles reimbursement scheme (ARRS) underscore the NHS commitment to tackling these issues. But these policy ambitions are pipedreams – as highlighted by the Fuller stocktake[3] – unless further work is done to facilitate a truly cooperative premises occupation culture for providers of all services. 

I work for a practice that serves a population of close to 22,000 patients. We have access to 26 rooms across two buildings, 4 miles apart. Our current space allocation and local geography restricts occupation, and leads to space constraints that limit our ability to deliver wider PCN services. We are creaking at the seams, and there is simply no space to accommodate transformational agendas such as those included in the NHS Long-Term Plan under the current circumstances, underscored by the fact that we are already directing midwifery and other important services to alternative premises. ‘Business as usual’ primary care must come first with what little space and resource is available to us.

Despite this, we have done our best to embrace the direction of travel. Working closely with the Local Authority, we offer a range of supplementary ‘wrap around’ services that many patients rely on to support and maintain good health and wellbeing. These include social prescribers and social care support teams, both of which help to tackle the root causes of patients’ problems, and empower them to make pro-active lifestyle choices to address them.

Livewell Derby is a local service helping people to lose weight, get fitter, stop smoking and improve their health are delivered from the council library and disjointed from primary care services. This means patients are unable to fully reap the benefits of true place-based, provider-partnership working. The inability to hold complex-needs muti-disciplinary team (MDT) meetings, share knowledge and learning, or even know each other’s first names through incidental ‘staff room encounters’ all impact detrimentally on our ability to address the social determinants of health in a given place.

Sinfin is piloting one of NHS England’s (NHSE) six pioneer integrated care board (ICB) owned health and wellbeing centres. This presents an enormous and unprecedented opportunity to align clinical and estates strategies in a way previously unseen across primary care in the NHS. System control of assets enable the co-location of NHS- and non-NHS-services to a degree that was simply not possible historically. Most importantly – and provided we have an appropriate seat at the table – it will enable us to deliver improved PCN services, which in turn will build resilience across our patient communities to better manage their own long-term health conditions, and deliver the recommendations set out in Dr Claire Fuller’s recent stocktake report.

We in an exciting new period for NHS commissioning, and the learning curve for both commissioners and providers will inevitably be steep. But the opportunities of ICB-owned primary care estate are significant, I am very supportive of any developments that would embrace the above principles.

  1. https://www.gmjournal.co.uk/people-are-living-longer-but-facing-more-ill-health-earlier
  2. https://www.derby.gov.uk/health-and-social-care/joint-strategic-needs-assessment/key-documents/
  3. https://www.england.nhs.uk/publication/next-steps-for-integrating-primary-care-fuller-stocktake-report/
Riten Ruparelia
Riten Ruparelia

Dr Riten Ruparelia is a GP and PCN Clinical Director at Hollybrook Medical Centre in Derby.

He is a local leader, and in 2019 his practice were involved in the Derbyshire General Practice Innovation programme, innovating using a standardised multi-disciplinary team (MDT) diverse skill mix to better care for patients.

Last Updated on 1 September 2022