Dr Ursula Montgomery, a GP and Senior Clinical Advisor for Primary Care at NHS England and Improvement, stepped up to deliver the first HTN Digital Primary Care keynote speech on the future of general practice, in our second live talk of the day.
After doing a “stock take” of the past year and taking the audience through GP appointment numbers for 2021, Dr Montgomery – who is celebrating 25 years as a doctor this month – also discussed the impact of the pandemic on primary care providers.
“In all the years that I have been a GP, the last 18 months have just been incredible, for so many different reasons,” she said, recalling her experiences as a GP at the start of the pandemic, before she joined NHS England and Improvement.
“We had to change really quickly – very, very rapidly, general practice adopted remote triage to support patients and keep staff and patients safe, to use new tools in their kit, new training. It required us to really fine tune our telephone consultation skills, but also look at adopting other modes of consultation. We had to look at how to best to use video…and also at how to incorporate new ways [of working] such as virtual wards.”
“One of the remarkable things about general practice,” she said, “is our ability to innovate, and to be flexible and adaptable. We’ve seen this because, in the pandemic, we’ve not only dealt with COVID and set up home oximetry services to monitor patients in the community, but we’ve also had to start to recognise a new condition – Long COVID. There’s been services launched for that and there’s an enhanced service that’s been adapted for that, for teams to start to learn more about this condition.”
Citing the latest Long COVID figures from ONS – the Office for National Statistics – she added: “Under 1 million people [an estimated 962,000] are reporting symptoms after four weeks – but 89 per cent of those have had them for at least 12 weeks. About 40 per cent of people continue to report symptoms after 12 months, so this suggests that primary care will be having to adapt and have to recognise and look after people who are living with long COVID for quite a while to come.”
On the facts and figures, Dr Montgomery revealed there had been approximately 292 million general practice appointments over the last 12 months and, according to stats from NHS Digital, 26.7 million in June 2021 alone. “While still keeping the triage assessment model, we’ve been able to bring people more into the surgery and many patients are now coming in for face-to-face [appointments],” she said.
Discussing video and online consultations, the Senior Clinical Advisor added that there were over 2.5 million online consultations submissions in March 2021.
Switching over to the primary care delivery of the COVID vaccine campaign, Dr Montgomery said that they had been “amazed again” by the flexibility and speed of the sector to help provide vaccination – with over 1,000 PCN-led vaccine sites, including 600 community pharmacy sites involved.
“If we think about the future,” she continued, “for the most part, the changes that we’ve made in response to the pandemic have accelerated existing priorities. The pandemic has changed the way we deliver care – we’ve seen greater collaboration with partners, we’ve seen an expansion in our workforce, we’ve seen the role of volunteers, we’ve seen the use of digital and triage and navigation. And we’ve seen resilience through PCN footprints and the ability to deliver continuity of care.”
On the topic of addressing health inequalities, she added: “We’re really hoping with the pandemic – one of the good things coming out of it – is that we are becoming more focused on how we can take action to really address health inequalities, and we need to do that together.”
Touching on the NHS Long Term Plan, Dr Montgomery added: “It started to talk about GPs, community health and social care staff working together. It describes general practice as the ‘bedrock of the NHS’.”
In that document, she explained, “Primary Care Networks [PCNs] were first described. There are now 1,250 Primary Care Networks across the country, covering a variety of sizes of population, but typically 30,000 to 50,000 people. This move to tackling health inequalities – and really understanding what our population health needs – has really been brought home by the pandemic.”
But what about the future? The future of primary care holds, she said, “greater integration – [which] I believe is not a noun, it’s actually a verb, it’s a doing word. So how do we work in a more integrated way? We need to work without walls across organisations and we need the tools and the ability and the time to do that.”
“We need IT and digital transformation that will support that working together, across pathways with our colleagues in local authorities, the voluntary sector and other members of the NHS family,” she said, “and we also need to tackle the estates challenge in primary care – it’s a well-known fact that it is not in good repair across the country. That is one of the big challenges.”
Using some words and inspiration from car manufacturer, Henry Ford, Dr Montgomery said: “The other thing about integration is that it’s about ‘coming together is a start [sic: beginning], keeping together is progress, and working together is success’…this talks about how it’s not enough to just come together, we’ve got to be able to keep together. And when we keep together that means that we’ve got to go through those bits about new relationships that can be tough sometimes. As we overcome those challenges and get to understand each other better, we can really work together successfully.”
Finally, she concluded with a message to the audience: “Thank you for the incredible way you’ve transformed primary care and general practice during the pandemic, for the incredible way that you’ve worked together. Really, the future looks bright because we’ve been able to transform in the darkest of times and we’ve been able to innovate and we’ve been able to serve our patients. That has all the ingredients for success.”
To view the full session, and find out what Dr Montgomery had to say in the Q&A – including what she’d do with £100 million to spend on primary care – watch the video recording below: