A new report has made recommendations for primary care in the UK to operate at scale to improve patient outcomes and system efficiency.
It urged a move away from a process dominated by contracts to one defined by quality improvement metrics and population health.
The Stronger Together report outlined that a system of primary care at scale should be adopted to extend the provision of health and care services within a community setting through an integrated, team-based approach.
Zoe Richmond, contributing author and clinical director at the Local Optical Committee Support Unit (Locsu), said: ‘The report highlights that we all have a duty to better understand what each of the four contractor services of primary care do. There is so much to be gained from this enhanced understanding and collaboration. We need to encourage significant behaviour changes if we are to
truly optimise primary care. Data sharing and increased digital connectivity has been long overdue for optometry.’
Richmond told Optician there were lots of examples of how this was already done, such as general practice (GP) and pharmacy ensuring the right patients accessed optometry urgent care services.
‘Similarly, within primary eye care, we are well placed to discuss the risk of sight loss linked to smoking and can make people aware of their local smoking cessation services. Also, optometrists can signpost people who have recently fallen to the local falls teams. At the same time, optometrists are well placed to receive referrals from falls teams to deliver visual assessment as part of a comprehensive falls assessment,’ she said.
Richmond noted that the vast majority of eye care was already delivered in primary care optometry. ‘While there are eight million appointments each year in the hospital eye service, there are over 20 million appointments in primary care optometry, most of which are funded by the NHS. There are also 2.6 million GP appointments relating to eye concerns each year as well as around 270,000 A&E visits. Despite all of this, the number of people living with sight loss is expected to rise to 2.7 million within the next 10 years,’ she said.
Richmond added that as well as making sure all primary healthcare professionals understood what existing local optometric services were available outside of hospital, the optometric profession needed to broaden the scope of care delivered within practice to create more capacity within hospital eye services so those most at risk of sight loss could be treated.
Limited knowledge
Authors recommended that primary care contractors and commissioners should seek to develop a culture in which co-production of care was paramount and ensure each sector knew and understood how to best support improved outcomes for patients.
In the optometry section of the report, it was highlighted that there were variable levels of understanding of service and the public had very limited knowledge about what optical practices offer. It noted there was significant potential for community-based eye care services to provide diagnostic and preventative treatment that is provided in hospital.
All four contractor services contributed to the report, which was called Stronger Together: Collaborative Primary Care at Scale, and published by Public Policy Projects and Healthworks. Other contributors from the optical profession included: Richard Whittington, departing CEO at Locsu; Adam Sampson, chief executive at the Association of Optometrists; Lesley Longstone, chief executive and registrar at the General Optical Council; Paramdeep Bilkhu, optometrist and teaching fellow at Aston University; Charles Barlow, optometrist and director of the Central Optical Fund; and Debbie McGill, head of policy and public affairs at the Association of British Dispensing Opticians.
It was written after a series of roundtable discussions as part of a State of the Nation Series into the challenges and opportunities facing the primary care sector.
Remodelled approach
Project chair, Professor James Kingsland, explained the report was written by, and for, primary care contractor services in the NHS – dentistry, GP, optometry and pharmacy. He added that it tackled historically siloed approaches to addressing and reforming primary care by highlighting challenges that were unique and shared among the four professions.
‘Our report deliberately avoids simply reframing the well documented challenges facing the NHS. Restating the need for more funding and workforce shortages in a post-Covid environment with increasing demand in an ageing population is no longer helpful. Instead, we have tried to create a new perspective by sometimes “thinking the unthinkable” and describe a system of primary at scale that focuses less on process and transactions to a more qualitative improved, patient-centric model,’ he said.
Kingsland outlined that the ‘sometimes uncomfortable but necessary blend of NHS and private funding’ that existed may need to be remodelled. ‘Our view is that this need not be an intractable issue and that more efficient and truly integrated use of contractors’ resources would better support both the NHS and the strengthening of independent contractor provision,’ he said.
The Stronger Together report called for a better understanding of what each service does within a local health economy beyond contractual obligations. ‘We present an authoritative opinion that there is much more potential – and appetite – for braver collaboration that would be to the benefit of all parties,’ Kingsland explained.
He said the report proposed a rethink of the performance managed approach to expand primary care provision and move towards an outcomes-based commissioned model with metrics that mattered to patients.