A new neighbourhood-based system for GPs should be introduced as part of primary care reforms, according to a major new review.

Multidisciplinary neighbourhood teams should also involve specialists such as paediatricians, geriatricians and psychiatrists, according to the report. The Fuller Stocktake – an NHS England commissioned review by GP Dr Claire Fuller – was published yesterday and recommends a series of proposals to help reshape how GPs and community health providers work. The British Medical Association said the proposals would not solve the problems in primary care without more resources and staff.

Dr Fuller described the current system as “fragmented and causing frustration among patients and staff”. She said: “There are real signs of genuine and growing discontent with primary care – both from the public who use it and the professionals who work within it. Inadequate access to urgent care is having a direct impact on GPs’ ability to provide continuity of care to those patients who need it most. In large part because of this, patient satisfaction with access to general practice is at an all-time low. Despite record numbers of appointments, the 8am Monday scramble for appointments has now become synonymous with patient frustration.

“At the same time, primary care teams are stretched beyond capacity, with staff morale at a record low. In short, left as it is, primary care as we know it will become unsustainable in a relatively short period of time.”

She said with the launch of the new integrated care systems (ICS) soon comes with it the “biggest opportunity in a generation” for a radical overhaul in the way health and social care services are designed and delivered. “Primary care must be at the heart of each of our new systems – all of which face different challenges and will require the freedom and support to find different solutions,” added Dr Fuller.

The review calls for additional support for PCNs and includes ideas of how to reshape groups that work locally. It also calls for the alignment of clinical and operational workforce from community health providers at neighbourhood level.

The report says newly formed integrated neighbourhood teams, which should evolve from PCNs, are “perfectly placed to bring together the right partners to tackle people’s overall health and wellbeing needs”. Some specialists would have it written in their job plans to take part in community and mental health teams, the report says. The proposed changes, which are backed by all 42 ICS leaders, will result in improved patient care and will also help individual PCNs and teams better manage demand and capacity.

Dr Fuller said “two significant cultural shifts” would be needed for the proposed changes to work: a move towards a “more psychosocial model of care that takes a more holistic approach to supporting the health and wellbeing of a community” plus “realignment of the wider health and care system to a population-based approach”.

She said if the proposals in the review were properly supported to embed and succeed, they could provide the backdrop for transforming how primary care is delivered. “But these new systems alone can’t fix all the problems: we need action at every level,” she writes. “This report sets out a limited number of recommendations for NHS England, the Department of Health and Social Care (DHSC), and other national bodies that will enable local systems to drive change in their communities and neighbourhoods. This includes ensuring future national policy is designed to support and enable local systems to do what they need to do rather than apply a one-size-fits-all approach.”

Dr Rebecca Fisher, senior policy fellow at the Health Foundation, cautiously welcomed the findings, saying: “The Fuller Stocktake provides a vision for how primary care can set up neighbourhood teams to meet the varying needs of patients, including faster same-day care for people with one-off problems, and improved care for those with long term conditions who need to see someone who knows them. Core to this is the need to support better collaboration between PCNs and social care, particularly in supporting care in people’s homes. But with general practice facing unprecedented pressures to meet rising demand for services, Fuller’s recommendations will do little to improve the immediate issues that are putting pressure on general practice.”

Professor Martin Marshall, Chair of the Royal College of GPs (RCGP), said the review was ambitious. “It shares a number of key aspirations with the College about the future of general practice, and how general practice fits within the new Integrated Care System structures and the wider NHS – and the College looks forward to working with partners to help make it a reality,” he said. “The report outlines a direction of travel that the College has long advocated, with GPs providing system leadership, supported to work within integrated multi-disciplinary health and care teams to ensure patients receive appropriate and timely care for their health needs, and to provide continuity of care for those who need it most. There is also an important focus on improving the health of communities and on preventing illness.”

British Medical Association GP committee chair Dr Farah Jameel said: “There is much to welcome in this report, but we cannot shy away from the challenges facing us. Just today we see figures revealing that we’ve lost the equivalent of almost 400 full-time, fully qualified GPs in England in the last year, and we face sky-high demand as practices attempt to address a vast amount of unmet need in the community two years into a pandemic – often in completely inadequate surgery buildings. It’s refreshing to see Dr Fuller’s honesty about the scale of this challenge. GPs want to be able to provide timely care to all their patients, whether that’s an on-the-day appointment for someone who rarely needs to see a doctor, or ongoing treatment for a person with a long-term condition – but the reality is without enough doctors, we’re often left unable to do both. This report presents some bold suggestions on how to begin to address this – but it will ultimately be determined by the Government’s willingness to act to properly resource practices, while addressing recruitment and retention.”

Matthew Taylor, chief executive of the NHS Confederation, described the review as a “watershed moment” for establishing primary care as an integral part of local systems.

“Our members – from primary care leaders through to ICSs – agree that investing in local relationships, developing and supporting frontline workers, and maintaining stability in general practice are the key components to achieving fully integrated primary care,” he said. “If we are to get serious about ramping up prevention, improving patient outcomes including by tackling health inequalities, and providing more personalised care, primary care’s deep-rooted connection to its local communities cannot be overstated. While leaders are hopeful that the actions from Dr Fuller’s review will lead to tangible improvements, they are very aware that a lot depends on addressing what was out of scope. Falling GP numbers and other workforce challenges, insufficient funding, and contractual and commissioning arrangements have the potential to be major blockers in realising this new vision for primary care if they are not given sufficient attention nationally.”

NHS chief executive Amanda Pritchard said: “I have heard how much people value access to these vital services which is why I commissioned this stocktake to ensure that as we join up services through Integrated Care Systems, we make it as convenient as possible for everyone to get the right care for their needs at the right time. Secondary care consultants – including, for example, geriatricians, respiratory consultants, paediatricians and psychiatrists – should be aligned to neighbourhood teams with commitments reflected in job plans, along with members of community and mental health teams.”