One of the casualties of the snap general election was the next step in the planned devolution of health and care in London - bringing together hospitals, GP surgeries and local authority care and other services, but now there is a renewed impetus building behind this.
Devolution presents an opportunity to truly tailor our health system to local needs, possibly removing some of the top-down dictates which impede achieving this. London's great diversity and variation means the need to adapt locally is stronger than elsewhere in the country. GPs and practice teams are in a unique position to understand local needs, and share information on the communities they care for with the rest of the health and social care.
Building new relationships, not demanding new organisations
Primary care is currently trying to navigate the transformation process set in motion via Sustainability and Transformation Partnerships (STPs) and come out the other side with a model of working which is sustainable and enshrines our values. The best way to provide joined up care for the individual is to enable the individual people involved to build relationships and coordinate with each other. If you start forcibly integrating them into new organisations, that reorganisation sucks in all the time and money, while sapping motivation and innovation.
General practice can work with devolved government to provide the information and relationships necessary to coordinate services as we see the changes in people and communities before the rest of the health system.
Eyes on the ground
GPs and practice teams have been the eyes and ears of the health system for some time. For example we began to see growing waistlines and inactivity in communities long before the obesity and diabetes epidemics became the challenges they are today. We also saw empty playing fields and full takeaway shops because we work in the communities we care for. Schools, social services and community groups saw this happening at the same time.
It's when we see the start of a health challenge like this that there is a need for someone to listen to those raising the alarm, co-ordinate the different groups who are in a position to act and provide resource where it can make most make a difference.
Devolution can give London the autonomy to act quickly before the cogs of central government have even started to grind into action, give our leaders the opportunity to guide a co-ordinated response and put resource into early intervention.
What will devolved, co-ordinated care look like?
Currently the Mayor's office are providing funding to a number of pilots, most of which build upon existing work to join up care and address the wider determinants of health. These include the social prescribing pilot which has become synonymous with Tower Hamlets. In Haringey the licensing and planning powers to shape healthy environments are being considered at.
In Hackney, health and social care are looking to fully integrate both budgets and jointly provide services, with a particular emphasis on prevention. Although as ever, joining two under-size budgets doesn't fix the underlying question of cash flow.
One Lewisham Health and Social Care system has combining mental and physical health services with social care, while integration across Barking & Dagenham, Havering and Redbridge is aiming to deliver a personalised health and care service focusing on self-care, prevention and local services.
The opportunity is there for us to showcase what practices can do when they are the ones leading joined-up care and in doing so make sure it's our values which shape the next stages of the programme.
Ask not what devolution can do for you...
The offer from London general practice to the Mayor's office is that we can show where the need is in each of London's neighbourhoods and play our part to join-up all the people and services who can meet that need. In return the Mayor's office can use the powers they have to create a space for ground-up approach to these problems, in the NHS, local government and the third sector we can all vouch for the fact that's a better route to success than ideas pushed from the centre. We've been asking for the Mayor's office to take a role like this since Sadiq was elected last year, so it's pleasing to see that it may come to pass.
In many ways the values of general practice are closer to those of the multiple strands of local government than they are to secondary care, our model focuses on the health needs of a whole community rather than on specific illnesses. We recognise that the opportunities of a more co-ordinated approach between local government, primary care and secondary care is of benefit to everyone. Delivering this with very little money and while pushing against centrally imposed structures is the challenge we all face.