Blog from Lorna Kelly our new National Strategic Lead for Primary Care at Health and Social Care Scotland

I started in April as National Strategic Lead for Primary Care at Health and Social Care Scotland.   Having been immersed in primary care and the Covid response within NHS Greater Glasgow and Clyde for the past couple of years, it is great to be able to take a wider perspective.    A few weeks in, and I have some early reflections about the opportunities of the role, and the big issues coming up.    This is a completely new role, which gives me huge scope to establish and develop it from scratch, but also slightly daunting that there isn't a defined list of things to pick up from someone who has gone before.

My early priorities are to make connections so that I have a good understanding of the range of issues for primary care across Scotland, and establish relationships to make sure I stay grounded and informed as the role progresses.    It has already been a real privilege to travel virtually across Scotland to lots of different HSCP areas, and I've been struck as ever by the huge diversity of our small country and how services are constantly adapting to local needs.  Primary care operates in many different contexts both in terms of population and geography, and the range of other local services - whether that is in remote, rural and island communities, areas with high concentrations of deprivation, or extremes of age and complexity. 

There are some key areas where there is an opportunity to help shape the future national direction, policy and strategy and make sure that primary care is at the heart of these.   The ongoing development of proposals for the National Care Service will shape the future of integrated services.  Four years into the 2018 GP contract changes, Primary Care Improvement Plans (PCIPs) and the Memorandum of Understanding (MOU), the next steps will be critical and need to be informed by experience so far, current challenges and a renewed focus on the intended outcomes.   So much has changed in the last few years, and it is a key challenge to make sure everyone understands the range of services, how they work together and how best to access these – both for patients and those working in the system.  There are some significant commitments to progress including the recommendations from the Remote and Rural General Practice Working Group, and the more recent short life working group on Health Inequalities and Primary Care, alongside new opportunities like the primary care mental health funding and the place of primary care within the NHS recovery plan and workforce strategy.   Underpinning all of that, we still don’t have good enough data and intelligence for primary care to know what’s going on, how things are changing, and how outcomes are being affected.
       
Why do I think all of this is important?    Because universal primary care remains the foundation that the NHS is built on and we know that healthcare systems with strong primary care are more cost effective, have better outcomes and are more equitable.   Trusted relationships and continuity of care are repeatedly associated with lower health care costs, more satisfied patients, and fewer emergency admissions.     Across General Practice, Community Pharmacy, Dentistry, Optometry and Out of Hours services, in thousands of locations across Scotland, hundreds of thousands of people are in touch with primary care services every week, and those services work in partnership with a much wider team across different professions, sectors and agencies.     But the pandemic has upset the equilibrium and the delicate balance of relationships within services and with patients and communities; and it has shone a light on some of the cracks that were already there.   Many of the things that we value – like continuity, appropriate access and person centred care – are severely challenged at the moment.

As someone who spends a lot of time in the water, I like swimming pool analogies - like the one used so effectively by the Deep End practices.  It's a recurring theme of recent conversations that people working in health and social care feel like they're barely keeping their heads above water, let alone having capacity to change, improve and plan for the future.   They have been in deep water for a long time and are exhausted, and some have already had to get out of the pool.   So there is an urgent need for some strong buoyancy aids, whilst also recognising that this is a long game about sustainable, rewarding careers and supporting people across the life course;  not just staying afloat but being able to get to shallower water and put our feet on solid ground.   

There is an enormous amount of commitment, innovative ideas and desire for positive change from all the people I have met so far, which makes me optimistic about finding a way through all of this, and I am looking forward to continuing to work with new (and old) colleagues over the coming months. 
 

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