Proactive primary care

Proactive care keeps people well and focuses on prevention rather than cure. It includes those activities and interventions, which contribute to improving health and wellbeing by increasing self-reliance, capacity and resilience in patients, the people who support their care and across local communities.  

General practice is the most accessed part of the health system and holds a registered list – it is therefore uniquely placed to become the hub for proactive care in the future

Why is it important?

Self-care and offering peer support to manage long-term conditions has the potential to reduce the cost of delivering healthcare through decreasing A&E attendances, reducing hospital admissions, reducing length of stay and decreasing patient attendances.

London needs a primary care service that can systematically enable patients to self-care, provide behavioural change support and/or referring to those who can assist with improving health and wellness for all.

Current service

General practice is set up to be an “illness” service rather than a “wellness” service and is largely a medical model

There are some practices which provide lifestyle advice but it tends to be ad hoc.

What is the impact?

We are becoming more likely to develop “lifestyle” long term conditions through obesity, smoking, excessive alcohol consumption, poor diet, low levels of exercise and unhealthy lifestyle choices.

For example 40% of Londoners are predicted to be obese by 2035, teenage pregnancy rates remain higher than the English average, as are sexually transmitted infections, and London also has a high level of homelessness and relatively poor vaccination and cancer screening coverage.

What does the specification say?

There are five elements to proactive care;

  • Co-design – primary care teams will work with their local communities to design approaches to improve the health and wellbeing of the local population (for example engage young people, schools and youth workers to design new ways of communicating with young people living with a long term condition)
  • Developing assets and resources for improving health and wellbeing – work with local community resources to help empower people to remain healthy – for example building a map of local charity and community projects which patients could be advised to use.
  • Personal conversations focussed on an individual’s health goals – part of routine interactions with general practice will include discussions about wellbeing and health goals.
  • Health and Wellbeing liaison and information – general practice will extend into schools, workplaces and other community settings acting as an advice and liaison service.
  • Patients not currently accessing primary care services – general practice will find ways of reaching patients who do not routinely access their services (homeless, travellers, recent prison releases). They will also design ways to proactively follow up patients who do not attend – for example those who do not respond to screening or immunisation invites or recall sessions for chronic disease management and self-care.