So here’s the thing – all major NHS re-configuration strategies have Out of Hospital plans and enhanced primary and community health care at their core yet it is clear that the public remain, at best, sceptical and, at worst, downright opposed to shifting services out of hospitals into primary care settings. We are continually reassured that moving services closer to home will be better for patients, more accessible, more acceptable and more likely to secure patients’ compliance with their treatment programmes. Furthermore everyone seems convinced that better and more comprehensive management of long term conditions can be achieved by serviced delivered at patients’ GP surgeries and in primary care centres rather than in hospitals.
Of course the main reason for this scepticism and opposition is that improvements in primary and community health care services are always inextricably linked to hospital closures. Yet even if we could separate one from the other, I’m sure that there is still a significant credibility gap which Commissioners and NHS Strategists need to bridge before they can convince the public that they are better off receiving more of their services in primary care and community settings care rather than in their local hospital.
Why might this be the case? Well I think the main reason is that very few of us have actually seen the primary care nirvana. Whilst many have experienced good GP primary care, it is sadly rare to see this as an integrated part of extended and enhanced out of hospital services – primary care linked to advanced diagnostics and outpatient-style services that were previously offered in hospital settings. How many of us have entered the health service for care that they previously received in hospitals and then experienced a complete, high quality package of care without having to cross the hospital threshold?
I’m sure that the majority of you ready to quote good examples of joined up services built around the primary care setting are not sitting in densely populated urban or suburban areas – the main areas likely to be affected by sector-wide acute reconfiguration plans. These are the areas with the biggest variations in the quality of primary care and where plenty of people choose A & E Departments, Walk-in Centres and Urgent Care Centres to receive primary care rather than their GP Practices.
So – what can be done about it? In many respects this is a marketing or re-branding exercise, not least because more people than we realise must actually look upon the going to hospital experience favourably (if not actually like going to hospital!). We need to do a number of different things to change perceptions and really communicate the benefits – to disassociate the enhancement of primary and community care from the hospital closure agenda, promote better examples of what extended primary care actually is and, probably, find a way of giving this new model of care a new brand.
Easier said than done perhaps but it is time that we bring some fresh thinking to this issue or else we run the risk of losing a lot of excellent thinking and vision to what is essentially a PR failure – just ask Professor Ara Darzi about his Polyclinic model.