Winter challenges in primary care

The Care Quality Commission has a unique view of the entire health and social care landscape, and over the next few weeks we will examine the impact of winter pressures across all sectors; share examples of where we are seeing good practice; and highlight the need to take a whole system approach to planning for and managing heightened demand.

In the second of our blog series, Chief Inspector of Primary Medical Services, Dr Rosie Benneyworth highlights the challenges facing primary care and discusses some of the good work we’ve seen that address these challenges.

I know that winter can be a challenging time for primary care, with increased demand and pressure across the system compounding the ongoing challenges the sector faces. I also know that staff across primary care work extremely hard and do great work supporting the health and social care system to deal with these increased pressures and mitigate any extra risks for people.

In this blog I wanted to touch on some of the things we highlighted in our recent State of Care report that talk about how across the system, issues around access to care are creating challenges for providers, including primary care. And how we’ve seen these challenges increase during periods of greater demand like the winter months. I also highlight some of the key advice we’re sharing across the system to help support the public to make the right choice about accessing care.

I’m also keen to highlight that different parts of the health and social care system don’t experience these challenges in isolation from one another. The challenges experienced in primary care and the sectors response to those challenges directly impact secondary care and social care, and vice versa. This interdependency between parts of the health and social care system means our response needs to be focused on improving collaboration, cooperation and integration in health and social care. This includes integration of commissioning and integration of care provision.

Challenges and solutions

We know that workforce challenges remain a big issue for the sector and one that has a direct impact on access and the ability to respond to increased demand, these challenges include:

• Increased amounts of part time working
• Recruitment challenges in some regions in England
• Older GPs choosing to leave the workforce

As a result, many health and social care professionals are working in very challenging circumstances that can have an impact on their health and wellbeing. It’s important as a regulator, that where appropriate we work collaboratively with partners to address these issues.

We have though, also seen the innovative use of workforce to address these challenges, through the use of multidisciplinary teams with a variety of professionals including advanced nurse practitioners, nursing associates, physician associates, pharmacists, district nurses, mental health practitioners and social prescribing workers, all working in GP practices and reducing the demand on GPs themselves.

Our State of Care report revealed that one of the key issues driving demand was a lack of awareness among the public about the range of services they could access, leading to increased demand on easily identifiable service types.

We’ve seen this issue and increased demand more generally being addressed through greater collaboration and integration. There are currently great examples of primary care services working collaboratively with each other thorough federations and the development of primary care networks, and with other sectors to deliver better outcomes for people. It’s important that as moves to greater integration continue, primary care remains central to this work.

The challenge to date with workforce innovation and greater integration and collaboration is the variation in how they’re being applied, and we’re keen to work with partners to encourage more national support and guidance to show best practice and ensure the most appropriate application of both.

I’m also keen for us as a regulator to develop how we work with providers, commissioners, government and other stakeholders to support more effective integration and innovation that delivers better outcomes for people, especially in periods of sustained pressure.

Key messages for the public

One of the things all parts of the system can do to help mitigate risks for people and manage increased pressures during winter is to help share clear and consistent messages with the public to support them to access appropriate care.

Both NHS England and Public Health England produce useful resources to support people to understand how to stay well and it’s positive to see examples across the country of providers across the health and social care system working with commissioners and system leaders, using these resources to present a consistent message.. Some of the actions they recommend we advise the public are:

• Recognising if you’re in an ‘at risk’ group.
• Getting the flu jab if you’re 65 and over, have a long term health condition or are pregnant. And importantly people can get this at a pharmacy not just a GP surgery!
• Getting advice as soon as you feel unwell from a pharmacist or 111.
• Keeping warm at home.
• Checking in on vulnerable relatives and neighbours.

What’s particularly positive about this advice is that it recognises the importance of a whole system approach to winter pressures and directing people to the most appropriate service. This isn’t just an issue related to A&E departments or one that can be solved by general practice, we see some of the best outcomes through a range of providers and services working together to keep people well.