07 - 2025-06-18 IJB - Primary Care Action Plan – Strategic Update
North Lanarkshire Council · 18 June 2025
Back to Health and Social Care Integration Joint Board — 18 June 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 7 SUBJECT: Primary Care Action Plan – Strategic Update TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Claire Rae Chief Officer University Health & Social Care North Lanarkshire Author(s) of Report Dr Mark Russell Medical Director South Lanarkshire University Health & Social Care Partnership DATE: 18 June 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Dr Mark Russell ☒ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB note: • The progress of the Primary Care Action Plan (PCAP) as the overarching delivery framework for Primary Care transformation • The rationale for investing in a digital access platform to support both general practice and community service accessibility • The steps taken to enhance impact measurement and quality assurance alongside the development of a unified key performance indicator framework 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND 5.1. General practices are the main point of contact for healthcare services in Scotland. Most are run by GP partners as independent contractors, meaning they are businesses that have contracts with the NHS, rather than employed by the NHS. 5.2. In its recent report General Practice: Progress since the 2018 General Medical Services Contract (March 2025), Audit Scotland have commented that - • As with the rest of health and social care, pressure on general practice is increasing. • Compared to 2017, there are fewer whole-time equivalent (WTE) GPs. • Compared to 2017, the number of patients per WTE GP has increased. • Compared to 2017, direct spending on general practice as a proportion of overall NHS spending has decreased. • Scottish Government’s commitment to increase the number of GPs by 800 is unlikely to be met by 2027 as the total number of GPs has only increased by 135 since 2017. • There is insufficient transparency and assurance about general practice quality of care. • Robust national data about demand, activity, workload, workforce and quality of care in general practice continues to be lacking. Yes ☐ No ☒ N/A ☐
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3 • People are finding it more difficult to access healthcare at their general practice. • The public does not fully understand how and why general practice is changing. • The Scottish Government’s vision and strategic direction for general practice and wider Primary Care provision is unclear. 5.3. As has previously been reported to the IJB, the legacy of historical Primary Care investment in Lanarkshire over the last 30 years - with Lanarkshire now 12% below the National Resource Allocation Formula share of Scottish GP practice spending – has resulted in its now having the lowest Primary Care capacity in Scotland (whole time equivalent number of GPs 30% below national average). 5.4. As the most recent Audit Scotland report has highlighted (see 3.1), general practice access is a national issue. Due to its relative shortage of GPs, Lanarkshire is at the forefront of this challenge. 5.5. South Lanarkshire Integration Joint Board (IJB) holds strategic responsibility for Primary Care across Lanarkshire. Improving the accessibility and range of Primary Care services is one of the five strategic goals of the South Lanarkshire IJB Strategic Commissioning Plan 2025 – 2028. 5.6. Primary Care is also a key component of NHS Lanarkshire’s healthcare strategy, Our Health Together. 5.7. As detailed in the Primary Care Transformation Report presented to the June 2024 meeting of the IJB, the future for the provision of Primary Care lies not just with independent contractor services, but a broad range of services which provide care which meets the key principles of Primary Care – i.e. services which provide first contact care in a way which is comprehensive, co-ordinated,
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4 and provides continuity of care for patients. 5.8. The Primary Care Action Plan (PCAP) provides the strategic framework through which the IJB and NHS Lanarkshire seek to address the sustainability, accessibility, and efficiency of Primary Care services. Oversight of the delivery of this action plan sits with the Primary Care Strategy Board, chaired by the Director of Health and Social Care, South Lanarkshire University HSCP. As a core workstream of NHS Lanarkshire’s Our Health Together Strategy, programme management support is being provided by the NHS Lanarkshire Property, Planning and Performance Directorate. 6. PRIMARY CARE ACTION PLAN: OVERVIEW 6.1. The PCAP sets out to deliver a system of care that supports General Practitioners (GPs), enables multidisciplinary team delivery, and reduces pressure on general practice. It seeks to shift activity where safe and appropriate to other providers within a redesigned Primary Care system, with a focus on three key areas: • Creating meaningful alternatives for patients outside of traditional general practice. • Reshaping care pathways to reduce system inefficiencies and reliance on general practices as an intermediary. • Refocusing GP capacity on complex, relationship-based care. 6.2. Creating Meaningful Alternatives to General Practice 6.2.1. A key aim of the PCAP is to enable patients to access care without defaulting to general practice. This work is focused across three strands: • Efficiency and Effectiveness: Significant investment in PCIP (Primary Care Improvement Plan) services — such as pharmacotherapy, community treatment and care (CTAC), and musculoskeletal (MSK) care — has created capacity, but variation remains. A dedicated Efficiency and Effectiveness Group is working with GP clusters to improve productivity, standardise delivery, and reduce administrative burden on practices. • Redesign of Core Services: As part of transformation work, reviews have commenced of key services that are managed within locally, including district nursing and health visiting. These reviews will focus on improving the productivity and efficiency of each service but will also aim to create a coherent model of care that clearly defines roles, improves coordination, and integrates with wider system infrastructure (such as shared records and prescribing systems). • Creation of New Services: Work is underway to fill known gaps, including expanded first-contact MSK access and bringing a number of professionals together to create a new single point of contact for mild-to-moderate mental health and holistic healthcare needs.
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5 6.2.2. These changes are intended to reduce first-contact presentations to GPs and allow redirection to appropriate services that can provide direct intervention and so swifter access to patients. 6.3. Reshaping Care Pathways 6.3.1. Local analysis has identified that over 30% of current GP workload arises from work initiated or delayed elsewhere in the system. The PCAP identifies several workstreams to reshape this, namely: 6.3.2. Working with Secondary Care colleagues to develop problem-based care pathways which will reduce multiple referrals and aim to ensure that patient diagnoses are established more quickly and efficiently, improving patient care and reducing GP appointments and workload. 6.3.3. Mapping the circumstances in which GP practices are involved in transitions from Secondary to Community Care without adding significantly to patient management. Work is ongoing, for example, to ensure that Secondary Care colleagues are fully aware of the facilities which can be provided in NHS Lanarkshire treatment rooms and know how to refer to them directly. 6.3.4. The objective is to create clear, navigable care pathways that provide patients with timely assistance while reducing unnecessary administrative and clinical burden on general practice. This work is being undertaken in close collaboration with NHS Lanarkshire’s Interface Directorate. 6.4. Refocusing GP Capacity 6.4.1. GPs remain central to Primary Care delivery but are increasingly constrained by time and demand. Work to refocus practice clinical capacity is structured into two strands: 6.4.2. Facilitating a more effective general practice front door: Many practices continue to experience overwhelming demand, particularly through telephone contact. To address this, the Primary Care Improvement Team is developing a Care Navigation toolkit designed to help practices direct patients more efficiently to the right service at the point of first contact. In parallel, an appointment audit tool is being tested with a number of practices to provide better insight into how clinical capacity is allocated, with a view to enabling more strategic scheduling decisions. 6.4.3. Helping practices make better use of their existing clinical resources: A number of development programmes are underway to support this. These include an optimising workflow toolkit aimed at improving practice systems and reducing unnecessary work; the development of a coding support package to strengthen data quality and improve task delegation; and a structured approach to patient care coordination to enable more proactive follow-up and case management. In addition, a pilot project exploring the use of artificial intelligence to support medical scribing is being progressed, with strong interest from practices. This
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6 has the potential to significantly reduce administrative workload if implementation proves viable. 6.4.4. Across both strands, tools and resources are being co-designed with practices to ensure they are locally informed, practical, and scalable. This reflects a recognition that real change requires not only technical solutions but also support for practice teams to reflect, plan, and implement changes in how they deliver care. 6.4.5. The PCAP is now being further augmented by two further areas of developmental activity: Digital Front Door; and measuring impact. 6.5. Digital Front Door 6.5.1. As part of this wider programme of work, the Primary Care Improvement Team is also supporting the development of a digital contact solution aimed at improving patient access to both general practice and community services. A procurement process has been initiated to offer GP practices a supported digital contact platform which can be integrated into existing workflows. The intention is to provide a scalable, Board-wide solution that can help practices to enhance their digital contact offering in a way which augments their existing access systems. This will help to reduce pressure on practice phone lines. 6.5.2. In parallel, this platform will also be made available for use by pilot community services. The aim is to explore how a shared system can support a consistent, joined-up approach to managing patient-initiated contact across Primary Care and community teams. This work forms part of NHS Lanarkshire’s contribution to the National Digital Front Door Programme, which is being led by NHS Education for Scotland (NES), and is intended to inform how digital access infrastructure can be standardised across Health Boards in future. 6.6. Impact Measurement 6.6.1. A key priority for the Primary Care Strategy Board is to understand not just what services deliver, but the difference they make. While much of the early focus has been on improving service productivity, there is a growing recognition that measuring true impact requires looking beyond activity levels to outcomes that matter for patients, practices, and the wider system. 6.6.2. The Efficiency and Effectiveness Group has been supporting this work by coordinating efforts across CTAC, pharmacotherapy, and other services funded from the ringfenced Primary Care Improvement Fund (PCIF). This includes reviewing how time and resources are used, supporting quality improvement within GP clusters, and working with local teams to reduce variation and optimise delivery. Clusters have initiated work on almost 90 quality improvement projects, and one of the aims of the Efficiency and Effectiveness Group is to enable clusters to ensure that they create learning which can be
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7 used to drive change through its alignment with board-wide transformation priorities. 6.6.3. In parallel, work is underway to develop key performance indicator (KPI) dashboards that will allow both local teams and strategic groups to monitor performance consistently. These dashboards aim to provide visibility on productivity and service reach, and to highlight areas where further improvement or redesign may be needed. While this work is at an early stage, it represents an important step towards creating a culture of continuous improvement across Primary Care services. 6.6.4. However, activity and productivity alone do not equate to impact. To understand whether services are achieving their intended outcomes, further development is required to define and measure impact across three domains: • Patient-level impacts: Better access, outcomes, and experience. • Practice-level impacts: Reduced workload, greater team stability. • System-level impacts: Fewer avoidable admissions, better equity. 6.6.5. The Primary Care Strategy Board will continue to direct the next phase of this work: agreeing a common framework for defining and assessing impact across these domains, identifying relevant data sources, and considering how staff- side and patient input can be built into this process. This will complement the ongoing dashboard work by ensuring that our assessment of success reflects what matters to patients, to practice teams, and to the health and care system as a whole. 7. CONCLUSIONS 7.1. Despite significant ongoing work to improve the stability and long-term viability of primary care in Lanarkshire, significant challenges remain. 7.2. The Primary Care Strategy Board, led by the Director of Health and Social Care, South Lanarkshire University Health and Social Care Partnership, has agreed a program of work to improve patient access and improve the sustainability of the care provided by GP practices. However, given the ongoing mismatch between capacity and demand in Lanarkshire, whole system change will be required if the demographic challenges of the next few years are not to result in significant further worsening of patient access. In particular, there will be a requirement for close working across both partnerships to ensure that the need for a co-ordinated approach to care between General Practice and community services is met, and that transformation to community services to meet this challenge is undertaken.
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8 8. IMPLICATIONS 8.1. The work detailed here directly contributes to the delivery of the IJB Strategic Commissioning Plan strategic goals, specifically: • Do the right thing first time • Increased focus on prevention, early intervention and tackling inequalities by working with communities and people • Develop and support a workforce for the future 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A
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9 8.31 Current financial challenges make service redesign challenging and also vital to ensure continued high-quality care. 8.32 The PCIF is heavily committed and therefore ongoing reviewing and revising of workstreams to ensuring available resources are deployed appropriately – and in a manner that reflects the principles of Getting it Right for Everyone (GIRFE), Realistic Medicine and Value-Based Health Care – continues to be critical. 9.2 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.21 Given hosted responsibilities, there currently no direct risk for the HSCNL delivery plan. 9.22 The work detailed here also contributes to addressing the following high-level risk within the NHS Lanarkshire Corporate Risk Register: • Ability to maintain General Medical Services provisions. 9.3 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery
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10 ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Ongoing engagement with the GP Sub-Committee and Cluster Quality Leads is in place to shape both the digital and evaluation frameworks. Work is taking place under the direction of the Primary Care Strategy Board to ensure that services are co- designed with patients and align them to their needs. 9.4 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A A full Integrated Impact Assessment will be undertaken before commissioning of digital access infrastructure. EQIA added to website: Yes No N/A 9. BACKGROUND PAPERS
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11 Audit Scotland - General Practice: Progress since the 2018 General Medical Services Contract (May 2025) https://audit.scot/uploads/2025-03/nr_250327_general_practice.pdf 11. APPENDICES N/A CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Dr Mark Russell Medical Director South Lanarkshire University Health & Social Care Partnership