NHS 10 Year Plan and the new left shift

Dr Anna Barnes has a feeling a déjà vu as she contemplates NHS plans for neighbourhood health centres

A couple of clichés come to mind as I begin this article:

• There’s nothing new under the sun
• Been there, done that, got the T-shirt

These sprang to mind when I read the NHS 10-year plan and saw the sections on the neighbourhood health centres (NHCs), which will:

• operate 12 hours a day, six days a week
• house GPs, nurses, pharmacists, mental health professionals, social care workers, and more under one roof
• provide services such as diagnostics, post-op care, rehab, palliative care, and even dental services
• offer non-clinical support like debt advice, employment help, and weight management programmes.

The aim is to reduce hospital admissions, cut waiting lists, and improve access to integrated care.

The plan’s second major shift is from ‘sickness to prevention’, aiming to tackle health issues before they escalate. Initiatives include:

• primary prevention (e.g., vaccinations, healthy lifestyle promotion)
• secondary prevention (e.g. early detection and screening)
• tertiary prevention (e.g. managing chronic conditions to avoid complications)
• a focus on the social determinants of health such as housing, education and employment.

This is an acknowledgement of the impact of health inequalities on health outcomes. It was, of course, much discussed during the Covid pandemic because of its disproportionate impact of the disease on deprived communities, ethnic minority groups, and people living in poor housing.

We’ve been here before

The reason for feeling slightly jaded and having a sense of déjà vu is that the strategic imperatives do not seem like new for those of us who were working in primary care circa 2002-2010.

The movement to create polyclinics was one such initiative coming out of the 2001 NHS Plan. More comprehensive, easily accessible primary care services were seen as necessary to assist in the modernisation of the NHS, along with an increase in general practitioners and, yes, an emphasis on reducing health inequalities.

The NHS Plan was followed by a focus on delivery via the Our Health Our Care Our Say White Paper (2006), which set out proposals for earlier intervention, an expansion in community-based care, various preventative and public health measures such as NHS life checks, increased support for people living in their own homes and (once again) a focus on reducing health inequalities.

Finally, the key policy document which effectively introduced the multi practice poly clinic model was Ari Darzi’s High Quality Care for All (2008).

Although this key document was not centrally concerned with primary care, the emphasis on prevention, care closer to home and integration of services was a useful lever for commissioning bodies to press ahead with an expansion of primary care.

While initially piloted in London via the 2007 Health Care for London initiative, HQCFA recommended widespread expansion of primary care. The 2008 national Darzi review (High Quality Care for All) built on this, encouraging more integrated and networked models of primary care adoption of the polyclinic or federated GP models working together collectively.

Where I worked in Hastings, commissioners (by now PCTs) adopted the Darzi model with enthusiasm, producing a strategy for building three new primary care centres which would meet all these strategic imperatives:

• Increase the critical mass of GPs and address recruitment shortages.
• Improve the scope of services in primary care and therefore improve the quality of services in primary care.
• Take inappropriate activity out of hospitals.
• Operate 8am-8pm.
• Offer community dentistry.
• Provide a walk-in centre as an alternative to A&E.
• Provide access to ‘secondary care’ services such as mental health, sexual health, community diagnostics such as x-rays.
• Offer space for specialist support such as local job centres.

The overarching aim was to reduce health inequalities (again, I know) by improving access to primary care in new, purpose-built facilities, which would include disabled access, for example, which was a major barrier for people in the old Victorian GP premises.

Reviewing previous success

Now perhaps it’s becoming evident why I think the 10-year plan looks familiar? So, now feels like an appropriate moment to look back and see what we achieved, seeing as we are seemingly revisiting these key policy imperatives.

In Hastings we only built one primary care centre, not three, although I think two others were financed by the Lift programme. The Station Plaza Primary Care Centre achieved the following:

• It integrated Sexual Health Services into its offer, thus improving access within a town centre site.
• It integrated five GP practices into one building and provides more comprehensive services.
• It provides community dentistry and a community pharmacy open 8am-8pm.
• It is fully accessible to disabled people.

The premises are far superior to what was on offer before and are offering more comprehensive services.

What I would now like to examine is where it did not achieve and examine the reason for this:

• It did provide an NHS walk-in service as an alternative to A&E for minor ailments and patients requiring primary care. However, this closed within 10 years because of a lack of commissioning support. This is despite its popularity with homeless people or others who are not registered with local GPs. The cut was later reversed, and it was rebranded the Hastings Primary Care Hub with reduced opening hours.
• The building is equipped to provide diagnostic facilities such as X-rays, but the local acute trust was wary of losing this income stream; it’s possible this was exacerbated by a lack of staff and commissioners not being able to resource a fully functioning alternative to A&E in the town centre.
• Links to job centres and mental health services were never really exploited; possibly the operational silos were not broken down sufficiently.
• Health promotion and public health initiatives also, to some extent, fell by the wayside. Substance misuse services, for example were decimated when public health commissioning was taken into local authorities, and the abolition of Public Health England (responsible for health promotion) was a very high-profile example of scores being settled post-Covid when blame was being apportioned for the UK’s poor performance compared to other European comparators.

More than warm words

This leads me to the conclusion that, for NHCs to work, there must be a real political imperative to invest in more than warm words. Tackling health inequalities (yes, them again) requires a timescale longer than even two parliaments and a wholesale shift in resources, as well as the will to break down operational silos.

Major shifts in the prevention of disease caused by poverty and lack of access to healthy food, sports facilities, etc., cannot be the responsibility of the NHS alone, so NHCs will need to be supremely well integrated with local authorities to make a real difference.

Tracking health outcomes needs time and joint commitment, not political short-termism. Thinking back to the outcome studies showing the effectiveness of the Sure Start programme of the evidence before it was cut, we know we can do it.