Primary and Community Health Steering Group minutes: May 2024

 

 

Attendees and apologies

• Director of Primary Care Directorate, Scottish Government
• Deputy Chief Medical Officer, Scottish Government
• Chief Allied Health Professions Officer, Scottish Government
• Delivery Director, Preventative and Proactive Care Programme, Scottish Government
• Professional Nurse Adviser for Primary Care and Chief Nursing Officer representative, Scottish Government
• Director of Dentistry, NHS Borders
• Director of Allied Health Professionals, NHS Fife
• Deputy Medical Director for Primary Care, NHS Greater Glasgow and Clyde
• Associate Medical Director Primary and Community Services, NHS Borders
• Director of National Centre for Remote and Rural Health and Care
• Director of Pharmacy, NHS Borders
• Scottish Executive Nurse Directors (SEND) Representative and Executive Nurse Director NHS Ayrshire and Arran
• Director of Midwifery, NHS Western Isles
• Chief Executive, NHS 24
• Chief Executive, Scottish Ambulance Service
• Head of Audiology Services, NHS Tayside and Board Member of the British Academy of Audiology
• Director of Psychology (NHS Fife Psychology Service) and Vice Chair of Heads of Psychology Scotland (HOPS)
• Chief Officer South Lanarkshire HSCP and HSCP Chief Officers Representative
• Nurse Director, Angus Health and Social Care Partnership
• National Strategic Lead for Primary Care, Health and Social Care Scotland
• Interim Director of Primary Care and Counter-Fraud Services, National Services Scotland
• Director of Nursing and Systems Improvement & Deputy Chief Executive, Healthcare Improvement Scotland (HIS)
• Medical Director,  National Education for Scotland (NES)
• Director of Digital, National Education for Scotland (NES)
• Director of Place and Wellbeing, Public Health Scotland (PHS)
• Out of Hours (OOH) Oversight Group Representative
• Deputy Chair, Scottish General Practitioners Committee of the British Medical Association (SGPC BMA)
• Chair, Royal College of General Practitioners Scotland (RCGP Scotland)
• Associate Director, Royal College of Nurses (RCN)
• CEO, Community Pharmacy Scotland
• Director for Scotland, Royal Pharmaceutical Society
• Professor of Medical Education, University of Glasgow and Co-Director of the Scottish School of Primary Care
• Professor of Health Economics, University of Glasgow
• Head of External Affairs, Queen's Nursing Institute Scotland (QNIS)
• Senior Officer of Development, The ALLIANCE
• Chief Executive, Voluntary Health Scotland
• Primary Care Strategy Unit, Scottish Government
• Primary and Community Health Steering Group Secretariat

Apologies

• NHS Board Optometric Advisor, NHS Greater Glasgow and Clyde
• NHS Board Digital Leads Group
• National Director, British Dental Association Scotland
• Chair, Optometry Scotland
• General Practice Managers Network

Items and actions

Please note: views expressed during the meeting include working positions under development, which are not reflective of current Scottish Government policy.

Welcome from the Co-Chairs and introductions

The co-chairs provided a welcome and overview of the steering group’s purpose and role.

The importance of the group and its work was emphasised, with the co-chairs noting it would support development of advice to Ministers.

It was emphasised that that meetings of the group and the work it undertakes are not in any way intended to replace existing dialogues and bi-lateral discussions between Scottish Government and individual organisations, but rather be a collaborative forum on the overall strategic approach for primary care and community health policy. The complexities and interdependencies within the system make this type of dialogue particularly critical.

It was noted that advice developed through the group will input to development of the National Care Service (NCS), with the broader role of primary care and community care in understanding and shaping population health also highlighted. 

The co-chairs recognised that the agenda for the first meeting had a focus on primary care but noted the importance of community health and work in this regard as the group develops.

Primary care – context, value, opportunities, and challenges (including discussion) – National Strategic Lead for Primary Care, Health and Social Care Scotland

The presentation highlighted that a strategic approach to primary care must be seen within the context of integration across health and social care, reflecting the reality that primary care does not work in isolation but has critical relationships across the system.

Primary care is the bedrock and first point of contact for very many of those using or accessing the health and social care system. Primary care is a part of care pathways throughout the wider system.

The majority of provision is through independent contractors, bringing both strengths and challenges. The presentation emphasised this is not just a legacy model, but one which continues to be effective.

Specific strategic challenges including burden of disease, workforce, and funding were highlighted. It was noted that in respect of balance of care and funding, the current position is not one that was necessarily intended during individual policy development and choices over a period of time. Important that a strategic approach reflects and considers the impact and effect of health services provision on wider social and economic outcomes.

There are some challenging trends, including financial viability for contractors, access to some services, balancing meeting urgent demand with preventative care and early intervention, and workforce development.

These should be seen in the context of the strengths across primary care including its bedrock role and status as the ‘front door’ of the NHS, the sector’s ability to manage risk and complexities in care pathways aligns with what is needed to respond to the changing burden of disease, changes in how multi-disciplinary teams (MDTs) are utilised and building up continuity of care within the community.

Shared aim of ensuring we can collectively deliver the right services to better outcomes at lower costs in the future.

Discussion around the presentation covered a number of areas:

• role of primary care in population health at a national level and managing and responding to risk and complexity in individual patient groups, reducing the burden on secondary care services 
• extent to which both how primary care operates, and its strengths and challenges are fully understood by patients and the wider system
• challenge of balancing long-term ambition with more immediate demands and funding priorities
• importance of recognising areas where continued joint working across the system will be essential to the continued role and impact of primary care, including continuity of care and MDTs
• recognising and exploring opportunities for improvement through ways of working such as clusters 
• workforce development considerations should include capacity and workloads so careers in primary care are tenable and attractive and there is scope for education, development, and innovation across professions. Discussion on quality improvement framework, education, and value of primary care academic research in this context
• digital and data innovation and infrastructure is both a benefit to be realised and a challenge, important that we collectively learn from experiences elsewhere
• mental health challenges and care should be recognised when considering primary care and integration. Emphasis on holistic person-centred approach, not just in context of MDTs but also going beyond – strategic focus on psychological needs of individuals 
• value in focusing on what various parts of the primary care system have in common

Primary care reform - connectivity with wider reforms and next steps (including discussion) – Primary Care Strategy Unit, Scottish Government

The presentation highlighted the strategic reform context in which primary care reform will take place - broad package of integrated health and social care reforms, operating under a draft vision for health and social care reform and joint principles set out by the Chief Medical Officer (CMO), as well as the place and role primary care has across wider reform in the NHS, the NCS, and wider reforms.

Scottish Government are developing the reform programme collaboratively – aligning with wider health reforms including NHS acute work (National Clinical Framework - NCF) and wider clinical priorities, wider health strategies e.g., mental health, and working with the NCS.

There are also cross-Health and Social Care alignments e.g. with Getting It Right for Everyone (GIRFE), Preventative and Proactive Care Programme, population health and digital transformation policies.

This wide and inclusive approach reflects primary care’s critical role as a connecter across wider health and social care systems.

Proposals to collectively develop a route map for primary care were discussed with the group. This seeks to take a person-centred approach, recognising the wider context of reform, and will set key enablers to deliver the role and vision for primary care in this wider reform context, and how these can be reshaped.

The route map will set out current operating model and future state for key enablers – including: 

• vision and role
• finance and funding models
• infrastructure, data and digital
• policy, standards and frameworks
• workforce
• contracts, governance, and planning
• innovation, best practice, learning and improvement
• the work will be iterative and recognise the diversity of the independent contractor landscape - what works for one part of primary care might not work for all of the system
• noted that much of this work is being done collectively to ensure join up. e.g. in improvement we are working with the Scottish Learning and Improvement Framework and Whole Systems Dashboard

The steering group will play a key role, alongside broader system engagement, in development of the Route Map, with ongoing engagement with broader colleagues to ensure an aligned approach overall.

Discussion around the presentation covered a number of areas:

• the approach to developing the route map was welcomed and seen as offering a comprehensive approach
• importance of integrating and reflecting patient views, lived experiences and the range of learning that already exists across the system into the route map
• part of the credibility of reform will be through it being developed with the sector and in consultation with public
• we must challenge ourselves to be as ambitious as possible and think about this work as an opportunity for transformational change, while recognised this has to be realistic and deliverable in the current context
• importance of using role, vision, and outcomes for primary care as core points of reference, and developing robust evidence basis for decisions, prioritisation, and policy
• there is significant transformation/reform needed in other parts of the system e.g., in secondary care, and we must ensure that these all link together
• including recognition and consideration of risk within the Route Map, identifying priorities, challenges, risks, and mitigations
• critical role and experience of the third sector should be considered
• integration of digital initiation and technological opportunities will be integral to success
• incorporating prevention and empowering people to self-manage as part of the primary care route map and wider work in the system

Annex 1: Summary of wider discussion points 

In addition to and alongside the discussion highlighted above, members discussed a range of topics, as highlighted below:

General Practice contracts

• role of the GP contract within overall strategic approach to primary care and reform

Digital/shared records

• scope for greater focus on digital transformation highlighted 
• Scottish Government noting work on single medication records, importance of drawing on evidence from NHS England

Workforce/professional learning

• need and value of more detailed and nuanced workforce strategy
• importance of interprofessional learning at early (undergraduate) stages of workforce education and development

Multi-disciplinary Teams (MDTs) 

• discussion on MDTs and importance of clarity and shared understanding of their role and how they can support delivery of outcomes linked to population health 
• importance of continuing to learn from demonstrator programme

Community Glaucoma Service (CGS)

• discussion on how CGS can support model of care based on delivering accessible care in communities 

Empowering patients/self-management and care 

• discussion on importance of empowering patients to be able to self-manage and self-care 

Digital and Artificial Intelligence (AI)

• discussion on role and benefits/challenges of digital and AI to service delivery 

Mental Health 

• discussion around importance of recognising mental health needs and challenges within primary care Route Map and reform, as a cross-cutting issue at societal level

Connectivity within system 

• the importance of connections between primary care, community health and other professions at local level

Continuity of Care

• recognising, supporting, and protecting general practice role in continuity of care

Innovation, research, evidence, academia 

• importance of research, evidence, and primary care academia in context of reform

Dental reform (Childsmile)

• discussion on dental reform, including Childsmile programme, and recognising and addressing health inequalities

Models of care 

• discussion on pressures impacting models of care 

Actions

Action 1: Members encouraged to provide further reflections or feedback on the presentations, discussion, and further thoughts to help collectively develop the Route Map for primary care to Scottish Government via the secretariat. All to consider. Complete

Action 2: group members to consider the Terms of Reference and Membership (circulated prior to the meeting) and any suggestions for how the meetings can best be run in the future and provide any comments to the secretariat. All to consider. Complete

Action 3: Scottish Government officials to consider individual or group discussions on specific areas – to include potential working groups and also follow up with specific members, e.g. third sector colleagues offered a follow discussion on her work programme. Complete

Action 4: secretariat to draft minutes/note of meeting and share for review. Scottish Government secretariat. Complete

Action 5: next meeting – Scottish Government officials to revert to members to identity a date, noted aim of group to meet again before the end of June. Complete

Officials issued a short survey following the meeting to gather broader views from across Steering Group Members.

Regarding action 3, following the meeting Scottish Government officials offered to members a smaller focus group meeting to focus on vision and role, with the findings to be brought to the next meeting of the Steering Group. This focus group took place on 12 June 2024.