Untapped primary care capacity in England highlighted by Specsavers

Specsavers made the case for utilising the available capacity in primary care in England during its Primary care without walls: making care closer to home real session at the NHS Confederation’s Care Closer to Home Conference in London on 24 February.

The breakout session saw primary care leaders coming together to discuss how an integrated, community-based model of care could succeed.

During the session, Stephen McAndrew, director of NHS Services at Specsavers, emphasised that “primary care is not just GPs.”

McAndrew told attendees: “Too often we hear, ‘we just forgot you.’ Yet pharmacy, optometry and dentistry are frequently the most accessible, most effective community-based parts of the health system.”

McAndrew used Scotland, where optometry and pharmacy routinely complete patient journeys without involving GP appointments, as an existing example of good practice.

“Scotland shows what’s possible,” McAndrew said.

“Patients receive safe, effective care closer to home, from professionals who already have the skills and infrastructure.”

He added: “We don’t need new buildings or diagnostic centres — we need to use what already exists.”

Dharmesh Patel, chief executive of Primary Eyecare Services, Amit Patel, chief executive of Community Pharmacy South West London, and Sara Hurley, the former chief dental officer for NHS England, also took part in the session.

The event was chaired by Dr Duncan Gooch, chair of the NHS Confederation’s Primary Care Network and a practising GP in Derbyshire.

Attendees discussed how England already has the capacity, capability and the community-based workforce that is required to deliver care closer to home.

They made the case that integrated commissioning, system connectivity and a change in mindset are needed in order for the opportunities available to be realised.

Structural design, rather than professional capability, remains a barrier to progress – and integration needs to be deliberate rather than accidental, the panel noted.

Amit Patel noted that England has fallen behind other UK nations – such as Scotland and Wales – which have empowered local primary care providers to shape pathways.

“We can deliver more — and we are ready to. But we cannot influence the ‘how’ if we’re locked out of pathway design,” Patel said.

Dharmesh Patel emphasised that the Government’s neighbourhood health plan needs to be co-designed in order to create genuine neighbourhood integration.

“We need the right leadership around the table,” he said, adding: “Integration cannot be designed in silos — yet this is still happening. Why is the Government not requiring co-production in every place?”

The panel suggested that those designing systems ask, ‘who is missing?’ during every planning, commissioning or budgeting meeting, and that they challenge siloed thinking – including having separate budgets for primary, urgent and elective care.

Hurley said: “When urgent care, prevention and routine commissioning are planned separately, we get reactive services.

“When they are designed together, community providers moderate demand and strengthen resilience.”

She added: “Siloed services recycle pressure. Aligned services reduce it. The difference is not funding alone – it is integration.”

System leaders should look for examples of good practice where integration already works, rather than reinventing models from scratch, the panel also emphasised.

They also noted that, rather than additional layers of governance, system design should focus on “mindset and connectivity.”

Integration requires a more integrated approach, McAndrew said.

“Primary care providers outside general practice are often the most community-embedded parts of the NHS,” he emphasised.

“They must have a seat at the decision-making table if we want genuine transformation and better use of resources.”