Progress in primary and integrated care

We thank the Future Healthcare Journal's editor-in-chief Andrew Duncombe, the publishing team at the RCP and the support of the FHJ board in producing a dedicated issue devoted to primary care and integration of care. There is much change in primary care at present, with the advent of integrated care boards, and work being done in the devolved nations in practice clusters, and we have chosen a wide remit of themes that we hope demonstrate the current challenges in primary care, the primary-secondary care interface and new ways of working that address new pathways of care. Work themes range from health inequalities, multimorbidity and prescribing to the use of information technology to support the development of the electronic health record – all of which need to be underpinned by education and training and world class research.

We are very fortunate to have an experienced set of authors who have admirably matched their brief and we thank them for representing the different perspectives and challenges in primary care. Helen Stokes-Lampard¹ and Claire Fuller² each set out the landscape on what integrated care means to health care professionals and importantly, patients. Owen Richards³ responds with a perspective on what the Fuller Stocktake means to patients. Kamila Hawthorne and Bola Owolabi⁴ provide a thoughtful and challenging paper around health inequalities in care and what our responsibilities as practitioners should and can be. Claire Lake and colleagues⁵ report on an innovative approach to managing challenging multiple health conditions across NHS Greater Manchester as an exemplar of integrated care.

We have sought UK-wide opinions on the Fuller Stocktake and in relation to health inequalities. Stewart Mercer's article links health inequalities, multimorbidity and integration of care in Scotland;⁶ Ellen Fallows highlights the importance of lifestyle medicine⁷ and we have three papers on information technology that highlight interoperability and the value of such technology applied to the electronic health record and direct patient care.^8–10

Prescribing is one of the main workload pressures in primary care, and we thank Tony Avery and Nick Boddy¹¹ for setting out the importance of the primary-secondary care interface and the value of prescribing decision support.

One of all our great challenges is how we address workload pressures in patient care through A&E. Agnelo Fernades and James Ray¹² offer a perspective that offers adoption of new pathways of care.

We have two papers covering education and training¹³ and research¹⁴ in primary care. But integration in health care delivery also lends itself to integration in research. The NIHR research networks offers a platform and exemplifies research across primary and secondary care. Judith Hayward and colleagues¹⁵ highlight genomics as an example of translational research that is being clinically applied with direct patient care.

Finally, we have commissioned some personal perspectives that illustrate different models of working from the inside. The first piece covers a variety of career paths, covering the partnership role in different types of practice, the salaried role and working in out of hours.¹⁶ The issue finishes with a reflective ‘life in the day’ of Nick Hayward, clinical director of his primary care network.¹⁷

After all this we hope the reader gets a comprehensive perspective not only on primary care as it is now, but as it might look in the future. This edition also show how we might work collaboratively across the NHS and social care, and offer cohesive, holistic care to our patients.

Kamila Hawthorne
Chair of Council, Royal College of General Practitioners, UK

Imran Rafi
GP and reader in primary care and genomics, St George's,
University of London, and co-clinical champion in genomics,
Royal College of General Practitioners, UK