“All of us have a responsibility to look after ourselves and take personal ownership for our health and wellbeing – but it is far more complex than simply telling people to eat healthily, exercise regularly and not smoke.”
Dr Andrew Hilton, chief executive of Primary Care Sheffield, the GP-led ‘social purpose’ company which spans the majority of Sheffield doctor’s practices, takes a wider view on solving the health crises facing the city.
Young doctors and nurses see working overseas as a more attractive option, while those towards the end of their careers seek to retire early
“Politicians and councils could do more to tackle the growth of high street fast food chains and make healthier options more affordable and available,” he said.
“Legislating the food industry to limit sugar levels in their products and educating the public to view the harmful effects of sugar in the same way they do fat would help with obesity and the increasing diabetes problem. Schools and employers could make it easier and more acceptable to fit exercise into the day whether it’s supporting walking or cycling to work, or exercise classes at lunchtime and subsiding gym membership.
“We need to support the public and patients to make the right choices not patronise them when they don’t.”
Hitting targets in healthcare are an ‘important mechanism by which to measure standards and achievement’, Dr Hilton believes – but there are often unwanted outcomes.
“There is little doubt targets such as seeing suspected cancer patients within two weeks of referral, or aspects of the Quality and Outcomes Framework which sets targets in general practice across a range of conditions, have driven up standards of patient care and improved long-term outcomes.
“On the other hand targets do have their unintended consequences, not least the additional layers of bureaucracy and data collection which as a front-line clinician can feel at times like it gets between the doctor and patient with a computer screen becoming an unwelcome third party within the consultation.
“Another issue is that national targets are used to performance-manage individual organisations overlooking the fact that health and social care are part of a complex interdependent system where a single organisation’s performance against a given target is likely to be influenced not only by their own actions but by the wider system beyond their immediate control. In future, national targets need to be developed with the whole system in mind.”
The demand on health services, and the professionals working within them, has stepped up ‘dramatically’ in recent years, both in hospitals and GP surgeries, he claimed.
“Young doctors and nurses see working overseas as a more attractive option offering better work-life balance, while those towards the end of their careers seek to retire early. In the future we need to create a more diverse workforce to better manage the demand and reduce the pressure on individuals.
“Primary Care Sheffield is keen to attract young doctors into general practice by creating portfolio careers that include the development of some specialist skills alongside their GP roles.”
The idea of a full, seven-day NHS service could be viewed as a factor in the pressure on staff, but Dr Hilton believes it is vital to offer certain services all week.
“Access to emergency and urgent health care seven days a week, 24 hours a day and free at the point of contact is a cornerstone of the NHS and should include access to the same level diagnostic tests and senior clinical oversight regardless of the time of day or day of week.
“Alongside the required access to urgent care we are seeing an increase in demand for routine services across seven days as people try to fit their health care around work and care commitments. This is why we have introduced our extended access service.
“Primary Care Sheffield now provides urgent care and routine nurse appointments, such as routine asthma checks and blood tests, on weekday evenings and weekends to improve access for those people that work, or need to be seen urgently, but struggle to see their GP or practice nurse in the daytime.”
The greatest challenge Primary Care Sheffield faces is in ‘managing the demand for services within the financial pressures’ the health system faces, said Dr Hilton. “We can only meet this challenge if we work together across our organisations, so that together we are all aligned with the needs of the public, our clients and our patients.”
Over the past year the company has been delivering a £9.3 million programme to improve patients’ access to health services and drive down inequality, including supporting groups such as elderly people, those with mental health problems and the Roma Slovak community.
Dr Hilton’s priorities for the next year are ‘threefold’, he said: “Firstly, we want to continue to support GP practices across Sheffield to maintain good quality care against a backdrop of financial pressures and increasing demand. Secondly, to build on the success of our four extended access sites to provide urgent care seven days a week, working closely with other services such as A&E, NHS 111 and the ambulance service. Finally we want to further develop our CASES scheme, which aims to build links between GPs and hospital specialists, provide peer review, education and support in order to develop more services for patients, which are based in their local community and integrated with their practice.”