Last month, Guidelines in Practice featured an article on changes to the structure of the NHS in England, and ran an online survey to gauge your views on the reorganisation and the impact it will have on general practice. A huge thank you to the many readers who participated and shared their opinions with us. Our Hot topic article provides an overview of the some of the survey’s findings, to be followed by a more detailed analysis that will be published online later in the year.

There are many positives to be taken from the survey—an important first step on the road to success is the ability to form local partnerships and work collaboratively, which many respondents see as achievable under the restructure. Overall, 78% indicated that these partnerships are either feasible (61%) or very feasible (17%). Furthermore, when asked whether developing a wider skill mix within primary care teams will lead to more comprehensive care for patients, only 9% disagreed, with 65% saying ‘yes’ and 27% saying ‘maybe’.

However, there are clearly obstacles to be overcome—more than half of you told us that there is insufficient funding to support workforce development, and a further 22% are uncertain whether the finances available for training and education are adequate. In addition, although the COVID-19 pandemic has underlined the need for greater health improvement measures, the pressure it has exerted on the NHS remains a barrier to progress. Three-quarters of you doubt that the restructure will lead to an improvement in patient care in the wake of COVID-19. 

Although much of the reasoning behind the move to create multidisciplinary primary care teams was to allow GPs to focus on the needs of more complex patients, fewer than one-third of respondents believe that this has occurred, and even fewer think that GPs’ workloads have decreased as a result of the changes. Worryingly, most members of the Guidelines in Practice audience who responded to the survey feel that primary care networks (PCNs) have insufficient influence in integrated care systems (ICSs)—93% do not agree that PCNs and ICSs have equal weight, and only 14% feel that they are working well together, with 50% stating that, although primary care has a voice in the new bodies, ICSs are exerting top-down control over PCNs.

Many of these changes will need to play out over time before the full effects can be determined, and Guidelines in Practice will continue to follow developments, as well as covering the concerns you have highlighted through the survey.

Restructures may come and go (and they frequently do), but clinical work must continue regardless, and among the other topics in this issue is a focus on the management of irritable bowel disease (IBD). A new national report from IBD UK—an alliance of 17 professional bodies, medical royal colleges, and patient associations—examines care for Crohn’s disease and colitis in the UK. Jackie Glatter and Dr Kevin Barrett highlight the need for personalised, proactive, and preventative management of the condition, delivered via a coordinated, multidisciplinary approach.

Gastrointestinal tract_AS

Vinod Nargund revisits the NICE guideline on lower urinary tract infection, examining the role of primary care and the judicious use of antibiotics. 

Also in this issue, Dr Natasha Halliwell offers some top tips on the management of attention deficit hyperactivity disorder. 

And in the View from the ground, Dr Jan O D Jablonski explains how an audit helped his practice to streamline the processing of lab results, leading to a reduction in the number of adult patients requiring intramuscular vitamin B12 injections. In the world of healthcare, small tweaks to a clinical pathway can bring about benefits to patients that are as important as large-scale changes at an organisational level.