When we are trying to understand the future for any individual service (like general practice) it is wise to try and understand what the future for the wider NHS looks like, as a framework to understand any potential changes.  So, what is the plan for the NHS?

The existing NHS Plan was entitled the NHS Long Term Plan, and it was published in January 2019.  While the headlines around it talked about it being a 10 year plan for the NHS, the document itself reads like a 5 year plan.  All of the specific commitments are limited to a 5 year time period, and anything else is described as “and beyond” (e.g. “It provides the framework for local planning for the next five years and beyond” p110).

The NHS Long Term Plan is of particular importance to general practice because it was the document that introduced Primary Care Networks (PCNs).  While there is a tendency in the wider NHS to think of PCNs as a general practice initiative, the reality is they were introduced as a cornerstone of the Long Term Plan ambition to “boost out of hospital care and finally dissolve the historic divide between primary and community care services” p12.

Importantly, PCNs were introduced so that, “GP practices – typically covering 30-50,000 people – will be funded to work together to deal with pressures in primary care and extend the range of convenient local services, creating genuinely integrated teams of GPs, community health and social care staff” p6.  As an aside, and regular readers of this column will know is a personal gripe of mine, the dealing with pressures in primary care part of this does seem to get lost in many ICBs’ interpretation of the role of PCNs.

Much has changed since 2019.  Matt Hancock has gone from being Secretary of State for Health to appearing in Celebrity SAS.  Simon Stevens has been replaced by Amanda Pritchard as Chief Executive of the NHS.  Covid happened.  We are now only 6 months from the end of the 5 year planning horizon indicated by the Long Term Plan, and from the end of the agreed period of the PCN DES.  Is the plan published in 2019 still the one the NHS is working to in September 2023?  Are PCNs still the plan to dissolve the divide between primary and community care services?

What the Long Term Plan was actually signifying was a closing of the internal market chapter of the NHS, that had been running since 1990.  It heralded the legislative changes that marked this closure, along with the formal creation of Integrated Care Systems (ICSs).  The new post-internal market system of ICSs is one based on collaboration and one that seeks to “deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care” (p10).

The fact that since the Long Term Plan was published Claire Fuller was asked to produce a document entitled “Next Steps for Integrating Primary Care” tells us a number of things.   It tells us the overall ambition to break down the perceived divide between primary care and both community and specialist care remains firm and an overriding priority.  It also tells us that the progress towards this so far via PCNs has been deemed as insufficient.

Meanwhile the NHS finds itself in something of a predicament.  The usefulness of the 2019 Long Term Plan has effectively run its course (or will have by March next year), and nothing yet has been produced to succeed it.  A general election is due before January 2025 (and therefore will probably take place next year) which makes the publication of any major new NHS plans (such as a new five year forward view/long term plan) unlikely in the intervening period.

So in this period of limbo most likely is that the status quo will more or less prevail, hence the widespread predictions for a one year rollover contract or similar for general practice next year.  When we look beyond that, the big strategic goal to bring primary care and community care closer together is highly unlikely to change.  This means more (not less) focus on groups of practices working together at PCN/neighbourhood scale, more focus on those groups working with other agencies across those neighbourhoods, and a continued shift away from any kind of focus of working at an individual practice level.