Improving access to primary care is a central plank of the new Labour government’s health strategy. Wes Streeting’s first ministerial visit as Secretary of State for Health and Social Care was to a GP surgery. The plan is to “shift the focus of the NHS out of hospitals and into the community”. Lord Ara Darzi’s rapid investigation into the state of the NHS, which reported this week, similarly concluded that community-based primary care services were essential to any improvements.
But not all patients have similar experiences of primary care. Young people report particular barriers to accessing their GPs, despite the importance of the service for prevention and early intervention and as a gateway to secondary care. Things they routinely raise include the importance of communication and trust, difficulties in fitting healthcare around education, difficulties in navigating systems for booking appointments, the critical role of privacy and understanding of consent, and having staff who understand their age group.
Making sure that improvements work for them is critical to their health – now, but also for their health as adults, and the health of their children. What the World Health Organisation calls the ‘triple dividend’ of intervention at this age.
And there are tested models that work by improving access for young people. AYPH recently undertook an evaluation of the Well Centre, a well-established, unique, free, confidential primary care service for 11-21 year olds that is currently being commissioned in Lambeth and Wandsworth. Launched in 2011, and led by general practitioners (GPs), in recent years the service has grown and changed. A significant number (approximately 1000) of young people aged 10-25 now access the service annually.
Initial assessment by a GP is followed by a flexible service delivery by either the GP, or other practitioners such as youth workers or mental health practitioners, as appropriate. In recent years the service has pivoted from general primary care to focusing more on mental health problems, partly responding to the needs of commissioners and the young people they serve.
Overall, the Well Centre is a hugely and universally valued service, and a critical part of the broader context of services for young people in the areas where it is commissioned. A range of positive impacts can be identified including improved experiences for young people, improved health, better communication between young people and practitioners, improved practitioner knowledge and confidence, improved access to services, good use of onward referral and diversion from crisis services.
There is much support for a wider roll out of the Well Centre’s approach, and a general sense that all young people should have the right to access this kind of tailored and expert support. However these are not easy services to design or deliver, and the challenges range from the funding context, the local complement of other services for the age group, the particular needs of the age group and the challenges of providing the right staff team at the right time in the right place, and supporting them appropriately. These are all considerations for a roll out or scaling up of the service, including how the service is situated and funded, how it is run, and what it seeks to deliver.
The Well Centre presents a worked example of what a ‘neighbourhood health service’ (in Streeting’s words) could look like for young people. Our evaluation discusses some of the challenges that need to be overcome in order to get this right, but also concludes that it is so important to try.
Author: Ann Hagell
September 2024