Fuller Stocktake: a patient view

When the Stocktake was announced, I was pleased to see Claire Fuller’s personal introduction on the website say “please get involved and tell us about your current experiences of primary care”. And then there were the various challenges, such as “living well” and “communities”. It all made me think that a patient perspective would be, if not central to the work, at least a significant component.

So I submitted some online thoughts about the importance for patients of having more information and transparency about what’s going on in relation to the new “I” landscape: ICB, ICP and ICS. Even better when someone (presumably from the Fuller team) thanked me for my comments, asked me to repost them on another workstream area, and also invited me to expand a little about how to achieve this greater transparency/comms. I took up that invitation, although a few alarm bells started to ring, inasmuch that I had imagined that the organisations that comprise an ICS should themselves already know a bit about comms, and be able to think of the basics of a regularly updated, public-friendly website containing key documents each with a plain English summary, plus a point of contact for feedback.

I wondered further when, as the months went by, there was nothing published on the Stocktake website about when the report was coming out. And then it emerged out of the blue.

The reason for this story is that I fear that the focus of the report seems to also be on what systems will do for us and to us, not with us. Claire Fuller said in the video, the Stocktake is to find ways to better “look after our populations”.

“The patient will be at the heart of everything the NHS does” says the NHS Constitution. But, in the world of the Stocktake, does that extend to patients being informed and engaged in how the services are designed, set up and managed, aside from one or two unelected people being given a seat on high-level committees? Because the Constitution also says “The NHS is accountable to the public, communities and patients that it serves”.

There’s some good words in the Fuller report:

• the Stocktake “heard consistently…that a ‘top-down’ approach…risks alienating the workforce and communities and hinders development of trusting relationships”
• the report recognises the importance of the neighbourhood level of operation: “throughout the stocktake, we heard that the PCNs were the most effective in improving population health and tackling health inequalities”
• community relationships were highlighted: “We have a fantastic opportunity to build on the outreach model that characterised the COVID-19 vaccination programme: developing meaningful and sustained relationships within communities”
• and patient input gets a look-in: “Critically, decisions about digital infrastructure in primary care need to be made in partnership with those who will use them – including engagement with both staff and patients”.

But there was no publicity targeted at patients and the public for the Stocktake or the report as far as I saw, and no flavour in the report of primary care patients having a say in what they want from the new integrated arrangements. The report doesn’t mention communicating to patients what is going on at system or place, how patients can help themselves, which services are available and how to choose etc. When it gives a purported example of working with people and communities, this isn’t about designing solutions in partnership with local communities, but about community health and wellbeing workers going out to talk to people and provide advice.

We can’t tell what input there was to the Stocktake from patients and representative organisations, because the report provides no information aside from the comments posted on the online challenge page. NHSE’s recent consultation draft of Working in Partnership with People and Communities says “It is a contractual requirement for every GP practice to have a Patient Participation Group”: PPGs could have been a starting point for communication and engagement.

My overwhelming feel from the report is encapsulated by the statement: “It is worth noting that most of the recommendations contained in this report are by systems for systems”. In other words, irrespective of some bits of helpful-sounding text, the whole exercise has been conducted predominantly for the NHS bureaucracy by the NHS bureaucracy. (Indeed, separate from the patient perspective, I note that the annexed framework doesn’t even contain the words “social care”, which seems surprising for the brave new world of integrated care systems.) I’m therefore not reassured that all 42 ICS chief executive designates were closely involved in the report and embrace it – it smacks to me of an exclusive, not inclusive process.

However, moving forward, we now have statutory provision for integration. I can merely hope that the next stages of the journey embrace openness, transparency and a genuine welcome to public/patient engagement at all levels of system and place. And that framework item 13 (work alongside local people and communities) has real meaning which we will start to see evidence of immediately from 1st July, if not before.