Imagine a world where Primary, Community, and Preventative care seamlessly converge under one roof - this vision is within our grasp with Government proposals: Neighbourhood Health Centres, Single Neighbourhood Provider (SNP), Integrated Health Organisation (IHO), and Multi Neighbourhood Providers (MNP).  Part of the government 10 years plan.

 

Experience has taught me that some Primary care Doctors don't want to work with Secondary care; they don't want to refer or work with others - a clear issue, at considerable detriment to patients.  This needs to change.  Some Primary care Doctors can frequently be found preaching on LMC Committees about how GP practice is 'at risk' due to the new 10 years government proposals arguing that fragmentation will impact 'continuity of care'.

As someone who has lost continuity of care through no fault of my own due to unresolved complaints, unethical behaviour and frustrations at a local GP surgery, I realised, whilst GP is important, you cannot 'put all your eggs in 1 basket', ergo fragmentation is needed - there really is safety in numbers.

Abandonment came at a huge shock - I thought I was safe with these people but they held too much power; there were conflicts of interests and just like that, the door was callously shut in my face forever, leaving me in the dark without any primary care.  It has been a long, hard journey for me, in recovery, but slowly the light switched on elsewhere...

I educated myself on Primary Care; the PCN, LMCs and saw that everything currently works to serve General Practice 'first and foremost' - however this is not always in patients' interests, owing to a perceived sense of entitlement; conflicts of interests, potential mis-use of power, poor governance of LMCs (to which GPs reside on) and  PCN monopolisation by the dominant GP surgery.  

I then stumbled across the government's new 10 years proposals, along this new road of recovery and enlightenment, so, after much consideration, reading and drawing on my own lived experience of disapppintment and hurt at my former GP surgery, I am here to advocate the new government proposals, which I strongly feel are in favour of patients, going forward.

Yes, GP is important and vital for healthcare however there are issues within it also:   

• Primary Care Networks (PCNs) focus on local, GP-led service delivery, whereas new government proposals introduce large-scale neighbourhood contracts that will shift general practices into subcontractors under external lead providers.
• PCN Monopolisation 
• A lack of oversight on Local Medical Committees (LMCs), to which GPs reside on.

Dangers of current PCN Monopolisation

• The dominant GP surgery secures the clinical director role within the PCN, aligning network priorities with their own practice goals (this will affect patient complaints/outcomes and will naturally result in conflicts of interests).
• The largest practice holds more voting weight.
• Misconduct can go undetected/unreported as GPs can hide as members or on committee roles.
• Management and HR functions get clustered in the main surgery.
• The dominant surgery controls key decisions, resource allocation, and funding streams.  This imbalance sidelines smaller practices, reduces collaborative decision making and centralizes power, leading to friction and inequitable patient service distribution across the network.

Benefits of the new government proposals -

• They will offer a formal, integrated contract structure holding legal and financial accountability - better governance.  Primary Care Networks (PCNs) offer a looser collaberation between separate general practice - the dominant surgery in the primary care network can cause inequalities amongst surgeries in your area, meaning you are not getting the care you should;
• Care closer to home;
• Less fragmentation - reduces administrative duplication and structural gaps which slows down commumity based care

Fragmentation in service provision often results in decreased accessibility and efficiency. Neighbourhood Health Centres (NHCs) are revolutionary because they offer a solution to this problem by creating a hub for integrated care.  Designed to break down silos, these centres ensure that Primary, Community, and Preventive health activities are aligned to provide holistic services to patients.  More people are living with multiple and more complex long term problems, and as highlighted by Lord Darzi, the absolute and relative proportion of our lives spent in ill-health has increased.

Neighbourhood health aims to create healthier communities, helping people of all ages live healthy, active and independent lives for as long as possible while improving their experience of health and social care, and increasing their agency in managing their own care.  Under this plan, elective care will be increasingly personalised and digital, with a focus on improving experience and convenience, and empowering people with choice and control over when and where they will be treated.

General Practice should work (and need to work) alongside community health, mental health, pharmacy, and social care professionals but there are persi stent frequent tensions...LMCs have a lot to do with this.

Pharmacy First is an NHS England service launched in January 2024 that allows people to get care for certain common conditions from qualified pharmacists, meaning they can walk into a high street pharmacy at a time that fits with their everyday schedule rather than having to book an appointment with a GP in order to get treatment.

Issued in Oct 25, by the BMA and regional LMC leaders, a leaked draft; faced backlash over a contentious letter distributed to regional GP practices that they were to avoid signposting patients to community pharmacies, controversially claiming that the Pharmacy First scheme relied on "less-skilled people" and aimed to downgrade patient expectations.  This contentious letter faced major backlash by pharmaceutical bodies, the Health Secretary and was condemned as 'adversarial, irresponsible, unprofessional and harmful to patient care'.  Some ICBs even issued immediate breach notices to practices refusing to enable the pathway.  This related to the GP contract 25/26 changes whereby practices were required to allow community Pharmacies to automatically feed consultation summaries straight in to the GP workflow via GP Connect Update Record by 1.10.25.  

Sadly, as at September 26, LMC members are now again attacking Pharmacy First as there are current plans to expand the Pharmacy First scheme so that patients can be treated for conditions including acne, migraines and ear infections without visiting their GP - this isn't undermining the role of GP (as stated by the LMC), but is prioritizing patient service access/speed in line with the government's 10 year plans - it is needed for quick turnaround.  Sadly, some Doctors do not wish to treat acne scarring (dismissing it as minor/insignificant), even going as far as to not issuing referrals to secondary care, ignoring the psychological/emotional impact it can have on patients on a daily basis or worsening of said symptoms (empathy deficit) so this is good news for sufferers who can get some treatment elsewhere - fragmentation and 'choice' is very much welcomed.   Currently, the NHS will only deal with 'severe acne cases'; and if psychological/emotional impairment is grossly affecting quality of life but then in saying that; some Doctors won't refer even in these cases (hardline, dismissive, insensitive approach).  If you come across a Doctor like this, find another.l - you shouldn't be made to suffer.

Pharmacists are valuable, highly skilled and trained people - you are in safe hands.  It is about time, people start valuing the importance of Pharmacists more within healthcare.

Statistics show that integrated health systems tend to have better patient outcomes and satisfaction levels. According to the NHS Confederation, integrated care can reduce unnecessary hospital admissions by up to 30%, proving its efficiency not just in terms of health outcomes but also in economic savings. Furthermore, reports indicate that countries with integrated health systems experience shorter hospital stays, increased patient engagement, and overall better health statistics.

We need a health system that addresses local needs. SNPs and IHOs tailor care delivery to suit specific community needs, while Multi-Neighbourhood Providers ensure that services are both expansive and inclusive. This integration is not only pragmatic but necessary to address the evolving healthcare demands.

By promoting these integrated health models, we will enhance service delivery, improve health outcomes, and build stronger communities. These organisations exist to close the gap in access to healthcare and provide a structure that’s proactive rather than reactive.

We call upon the NHS and other health authorities to increase funding and policy initiatives to support the development and expansion of these Neighbourhood Health Centres. This support is crucial for training staff, providing resources, and implementing the updated health models across our regions.

This has never been more relevant now for you to sign, as at August 26, the BMA are trying to argue with the government that NHS neighbourhoods should be built around existing PCNs and funded through local variation to the network contract directed enhanced service (DES) rather than new standalone contracts - this should not be the case.

Your signature can make a real difference. Join us in advocating for a more integrated, efficient, and patient-centered approach to healthcare. Together, we can build healthier communities through actionable change.

Please sign and share this petition to show your support for integrated healthcare solutions that truly serve our needs.