Fuller Stocktake: a vision for integrating primary care

The Fuller Stocktake report sets out a new vision for integrating primary care led by integrated neighbourhood teams.

The review was carried out by Dr Claire Fuller chief executive-designate of Surrey Heartlands ICS commissioned by NHS England and NHS Improvement and published in May 2022.

With the new ICSs and Integrated Care Boards taking on statutory duties from 1 July 2022, the report recognises this is a “moment of real opportunity” for primary care. The report describes an optimism that the new reforms to health and social care can provide the backdrop for transforming how primary care is delivered in communities across the county.

According to Dr Fuller “Primary care must be at the heart of each of our new systems – all of which face different challenges and will require the freedom and support to find different solutions."

All 42 CEOs of the new ICSs have put their signature to this report – and framework for shared action set out in the annex to the report. 

Enablers of integrated primary care

Recognising that a more streamlined and integrated model is required to serve the modern-day demands of primary care, the report identifies three essential offers:

• streamlining access to care and advice;
• providing more proactive, personalised care with support from a multidisciplinary team of professionals; and
• helping people to stay well longer as part of a more joined-up approach to prevention.

Shifting the focus to locally integrated team

At the heart of the new vision is building integrated teams in every neighbourhood – the ‘teams of teams’, which need to “evolve from Primary Care Networks”. This recommendation reinforces the continued importance of PCNs in realising the aims of this review.

This approach will provide an ecosystem that supports a bottom-up approach, giving neighbourhoods the ability to determine the most effective model depending on the demands of the local community while ensuring the PCN has the capacity to meet those demands.

Dr Fuller explains that successful examples of effective integrated care relied on a genuine partnership between the local population and the care network that serves it. Where local people made up the primary care workforce, it reflected the community it worked within making it capable of levelling-up the access to healthcare.

The capacity issue

How do we grow the overall primary care capacity? Dr Fuller suggests a single integrated pathway is required that can connect primary care, especially urgent care, to the wider care network. If this pathway is streamlined and easy for patients to navigate, then it will divert demand from general practice onto other, currently siloed, services such as urgent treatment centres, urgent community response services and community pharmacy.

Such a pathway would provide an infrastructure around general practice that would protect it from overwhelming demand and providing space for practitioners to deliver care to those who need it. As part of streamlining the pathway, building local teams around the demand of the local area, with input from primary, secondary, and social care, will allow for a more holistic approach to local care needs. The continued development of a digital infrastructure will allow networks to spot trends and prevent local health problems arising.

Comment

Notwithstanding the need for change, every effort should be made to ensure the current model is supported and collaborative practices used to drive improvements where required. Out of stability, and with strong leadership leveraging developments in data and technology, a culture can emerge that will be central to integrating primary care for the benefit of the community it serves.