Person-centred care in Scotland 3 - The primary care team

<- Read part 1, on 'Realistic Medicine' and part 2, on what can be learned from palliative care

Person-centred care, palliative and otherwise, it could be said, begins at home.

If culture change starts with a conversation, then that first conversation with health services almost always happens in primary care, usually with a GP or pharmacist.

But as care shifts from hospitals into communities, what will the primary care of the future look like? Reform of it is one of the central strands of the National Clinical Strategy.

New primary care ‘hubs’ are being tested in some parts of Scotland, while the ‘deep end’ GPs in the country’s most deprived communities are also developing links with other services and the third sector.

At the centre of plan is the idea of collaborative working between different practitioners, and last week seven of Scotland’s professional bodies contacted Holyrood to launch a shared vision of how that collaboration might work.

The definition is made up of 21 principles agreed by the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN), the Royal Pharmaceutical Society (RPS), Optometry Scotland, Community Pharmacy Scotland, the Allied Health Professionals Federation (AHPF) and the Queen’s Nursing Institute Scotland (QNIS).

Services should be delivered by “primary care networks”, they suggest, which would be built around the individual needs of the person they are treating and local communities, rather than a fixed multidisciplinary team. These networks would use “a mixture of clinical and social approaches” between “trusting and respectful” professional partners.

It sounds very like the ‘House of Care’ model.

Dr Miles Mack, Chair of the RCGP in Scotland, said: “Health professionals working in primary care services are at the heart of efforts to improve services for people in communities across Scotland. At a time when Scotland is facing radical health and care reforms across sectors, we have come together as professional leaders to put forward a united, multidisciplinary vision for the future of primary care in Scotland.”

Optometry Scotland chair Nicola McElvanney said she hoped the document would be “a positive contribution” to the reshaping of the NHS.

Theresa Fyffe, Director of the RCN Scotland, said: “Across our seven organisations we want to demonstrate our collective commitment to provide professional leadership in developing and implementing new ways of working. This vision builds on the skills and expertise of us all.”

Clare Cable, Chief Executive and Nurse Director of QNIS, said: “Central to our vision are people, not structures. Strong relationships are, and always should be, at the very heart of primary care. They will certainly be key to designing and implementing successful change.”

Harry McQuillan, Chief Executive of Community Pharmacy Scotland, said the seven organisations represented over 60,000 clinicians across Scotland, including AHPs, GPs, nurses, optometrists, dispensing opticians and pharmacists. “Our members are a considerable resource to help bring about change,” he said.

Dawn Mitchell, Convener, Allied Health Professions Federation Scotland, said: “Each of our organisations wants to work in genuine and open collaboration with the Scottish Government, with colleagues across health and social care and with the public to shape a new future for quality primary care in Scotland.”

The document was warmly welcomed by Health Secretary Shona Robison.

“The Scottish Government is already working to transform primary care using our £85 million Primary Care Fund,” she said.

“This will develop new ways of working that will help to put in place long-term, sustainable change within primary care services that can better meet changing needs and demands. We have also committed to giving primary care an increasing share of NHS budget in each year of this parliament.”

But with many decisions about the future of services still being made behind closed doors, a public intervention by the clinical experts in primary care might seem welcome to those who, after all, are supposed to be in the centre: us.