I had a fascinating conversation with Dr Joe McManners on the podcast this week, where he shared some helpful insights into what is required to make the shift of resources from secondary to primary care a reality.

The first point he made is that the more government and policy makers have spoken about shifting investment from secondary care to prevention, primary and community care the less it has happened. What this has made clear is that simply stating this change as a desired direction of travel on its own will not be enough to make it a reality, and that a much more structured approach is required.

For primary care, there needs to be a scaling up of infrastructure – of systems, data, digital capability, physical and workforce capacity – in order to enable this shift to happen.  Even if there was a sudden flow of money into primary care tomorrow, the infrastructure does not currently exist to be able to convert this into more activity.

The point Joe makes is that there needs to be a more sophisticated organisational infrastructure that can provide these things than currently exists across practices and PCNs.  PCNs are an essential part of the infrastructure – if they didn’t exist, we would be looking to invent them – but so far they have only fulfilled a fraction of their potential.  The infrastructure support is what is needed to help them get there.

What this organisational infrastructure will actually look like is something that policy makers will have to decide.  It does not need to replace practices and PCNs, but rather to exist alongside them, maybe as an umbrella organisation, with some nationally-driven development programme to support the implementation of this infrastructure across the country.

There is also the thorny issue of actually making the shift of resources a reality.  Although attempts to do this in past have failed, there can be learning taken from them.  For Joe the starting point is acknowledging not that changing the financial flows will be cheaper (it won’t, and many previous attempts have failed once this has become apparent), but rather that it will avoid a more expensive system in the future.  From this starting point there will need to be some initial double running, and then as evidence of success is developed longer term funding streams put in place.

For general practice this movement in the policy direction represents a huge opportunity.  The available funding for core service delivery is inadequate and needs to be addressed, but the potential for investment in the delivery of core general practice will always be limited.  However taking a leading role in building productive partnerships across local neighbourhoods to deliver better outcomes for specific populations (which may be outside of core contractual work) is not only hugely satisfying but is also the type of work that will ultimately make the shift of resources from secondary to primary care a reality.

You can listen in to everything that Joe said (which I strongly recommend you do!) on the podcast here.