Panel roundup - Prescription for Prevention: rethinking primary care
Researcher
On Tuesday, we were delighted to host Professor Dame Clare Gerada and Professor Nicola Ranger for a lively discussion on the challenges and opportunities facing primary care, what this means for the health of the nation and the medical profession.
The panellists discussed a range of topics: from the risks facing clinicians, to whether there even is a correct ‘front door’ for the health system, to the diminishing domestic primary care workforce.
There was much to digest after this panel (and keep a look out on our YouTube channel for the full video to be uploaded!). In true Re:State style, there were points of consensus and disagreement in equal measure. Some points of consensus included:
- Putting ‘money where your mouth is’
Anybody working in and around policy, and especially health policy, knows that there has been countless reviews over the decades highlighting the need to shift to a more preventative model of health. This was most compellingly expressed by Dame Claire Gerada, who brought physical props — in the form of multiple policy reports from the last 20 years — to illustrate how we have been saying the same things for decades. Most recently, the Government’s “three shifts” further cemented the rhetoric around the need to move from “hospital to community” and from “treatment to prevention”. And yet, with all this talk, the panellists lamented that this all of this just seems to be... rhetoric. Without investment and reform, this recycled rhetoric may well just continue in perpetuity.
- International comparisons
A point that was raised early on in the panel was the scale of primary care in other countries. India and Japan were two countries which were applauded for having a much larger primary care system. These countries have embedded their preventative agenda for populations not just in the thousands, but in the millions, and are seeing improved patient outcomes, workforce resilience, and continuity of care. They demonstrate that prevention can be done, but this was expressed with some caution: you cannot copy and paste approaches from different health systems as the operating environment can be completely different.
And there were genuine differences of opinion:
- The composition of the primary care workforce
At Re:State, we believe that the primary care workforce should be expanded to include more community health workers (CHWs), based on the model developed in Brazil. CHWs provide universal, comprehensive and integrated health and social care support to all families in a hyper-local geographical area, usually around 200 households. Indeed, we actually observed CHWs in Westminster and were slightly spellbound by the experience, as this blog demonstrates. However, our guests questioned whether the introduction of more CHWs will actually manage to deliver better health outcomes and improved efficiencies; instead, they suggested it might be more useful to change GP contracts to involve more district nursing. (for what it’s worth, we believe district nurses and CHWs serve completely different purposes, as is illustrated in our report, and if we want to shift to a model of prevention, we do in fact need both).
If you’d like to read about Reform’s views on how to reimagine the primary care system, then you should check out our three paper series on reforming primary care.