Chapter Nine Syndrome
Readers I commend to you the new publication from NHS England “Transforming Primary Care in London“. This excellent document pulls together a comprehensive understanding of the challenges facing primary care in London and the shortcomings of existing services. The section on new models of organisation is particularly valuable.
However, like so many well-meaning NHS strategic documents that have come beforehand, it suffers from what may, hopefully, henceforth be called “Chapter Nine Syndrome” [copyright Damson Health]. C9S is so-named because Chapter Nine is invariably where we find a few words about the estates and infrastructure problems facing the NHS. Estates matters are always problematic in the NHS and the report rightly notes some of the reasons, linked in many cases to GPs’ independent contractor status and how general practice has been funded since 1948 but also because of the difficulty in changing the huge NHS estate that has developed over years into something radically different and fit for a new purpose.
The report raises some major challenges to how general practice needs to be organised and delivered in the future to tackle need, improve care and outcomes and to transform hospital and out of hospital care. Transforming the primary and community health service infrastructure is absolutely essential to these changes, not simply desirable.
The report notes the mixed history of major developments in primary care pointing out that some new buildings have been under-utilised. However, under the NHS LIFT programme, over fifty state of the art buildings have been developed of the highest quality which, in almost all cases, are totally fit for purpose for delivering new models of out of hospital care such as better management of long term conditions, outpatients and diagnostics. In every part of London planning acute reconfiguration, these LIFT primary care centres are the lynch-pins of local out of hospital plans. Where these buildings are currently poorly utilised, this is largely because of an earlier lack of joined up thinking between infrastructure development and organisational development for primary care. Examples of “old wine in new bottles” has undermined this important programme but should not be allowed to derail what is crucial for any hopes to transform primary care and deliver the capital’s ambitious out of hospital plans.