Breakfast seminar

“We are in the middle of a storm right now,” Professor Robert Harris told Care Conversation delegates. “In any storm, in any sector, there’s opportunity, but for some reason healthcare hasn’t been able to grasp this.”

NHS England had slowly been losing its independent spirit and desire to change, he said, and the most exciting part of healthcare was now primary care. “The out-of-hospital model is the future, because hospitals are expensive and mainly designed to treat 19th century diseases.”

Despite this, primary care funding remained a fraction of the NHS budget, he stressed. “We could do some radical things in primary care to really shake things up, but we have to be willing to do it.” This required a “big mindset change”, however, with risk-taking ‘anathema’ to much of the public sector. “They’d rather just wait to be told what to do. So we’re in a groove and we just plough on in that groove.”

Around 90% of initial contact with patients was in primary care, he said. “It’s historically been small – a corner shop – but it is flexible, and I’d argue that bigger is better. We need list sizes of hundreds of thousands of people.” His organisation considered itself an ‘eco-system’, knowing exactly what patients wanted and how that could be provided. “Primary care needs to understand the people on its books much better.”

The funding gap in the NHS now stood at around £30bn, he pointed out. “We’ve got a small number of people consuming a disproportionately large amount of healthcare spend, so what do we do about that? We should be focusing on resource.”

Analysis was vital to understand the needs of patients, particularly the 5% who consumed most resources. “At Lakeside, we take responsibility for all aspects of our patients’ care, supported by a multi-functional care team. So as a patient, you get an advocate – your GP – haranguing people on your behalf.” This meant patient management, condition management and seamless handovers in the event of flare-ups, he said. “So we’ll take on this cohort of patients – and the risk – but subject to an agreement about at what point the specialists take over.

“We’re improving the offer, taking £2m out of a £10m budget,” he continued. “Financially it works, we’re enjoying it, the patients are enjoying it, and the doctors are enjoying it – it keeps them fresh and interested. This model is eminently scaleable as a primary care offer.”

The ‘bitter pill’ that hospitals would have to swallow, however, was reduced budgets. “Hospitals think that staff are fixed assets, and they’re not. The acutes need to properly engage with this – rather than just pull up the drawbridges – and that also needs politicians to get onside.” Every health economy had a five-year plan, he said, and his organisation could help them deliver almost all of the 12% savings they needed.

Ultimately, there were two ways to bring about change in the sector, he said –fear and encouragement. “But you need to have an offer that shines a light on the future. People want this, and the politicians will follow the people.”