Becks Fisher M.A. (Cantab), MB BChir, MRCP (UK), MRCGP, FHEA spent her fellowship at the University of California, San Francisco, mentored by Urmimala Sarkar, M.D., M.P.H., (Professor, Division of General Internal Medicine; Associate Chair for Faculty Experience, Department of Medicine; Associate Director, UCSF Center for Vulnerable Populations, San Francisco General Hospital) and Julia Adler-Milstein, Ph.D., (Professor of Medicine, Chief of the Division of Clinical Informatics, and Director, Center for Clinical Informatics and Improvement Research, UCSF School of Medicine). She has returned to her post at the Health Foundation and continues as a part time GP.
As a general practitioner in a deprived urban area, as well as a senior policy fellow at the Health Foundation, Becks chose to study the Organization and Management of Primary Care: Lessons from US health systems
Becks leads the Health Foundation’s work on general practice. She is particularly interested in how health policy can support equitable provision of primary care services and in models of care and payment for general practice. She has served on multiple national advisory groups, including NHS England’s health inequalities in primary care advisory group, and the National Vaccine Equalities Committee for the COVID vaccine rollout. Fisher is a cofounder of Next Generation GP, a national leadership program for early-career GPs in the U.K. She was previously a National Medical Directors clinical fellow to Sir Bruce Keogh, and an academic clinical fellow at the University of Oxford, where she held a teaching fellowship at Green Templeton College. She completed her medical training at the University of Cambridge, where she graduated with the Roger Morris Prize for medicine and surgery.
Becks’ project started from the premise that The United States and the United Kingdom share challenges regarding the delivery of high-quality primary care. Neither country has enough primary care physicians. Both have scope to improve the organization and management of primary care within their health systems. In the U.K., the “partnership model” of general practice is increasingly precarious. National policy is towards greater integration of primary, secondary, and social care, but what this will look like — in terms of the organization and management of general practice — is unclear. Policymakers are grappling with interrelated sets of questions. First, around the optimal size and scale of practices – and the infrastructure required to support practices of different sizes, and second around how to balance increased patient demand with the pressing need to reduce GP workload and increase job satisfaction. Considerations about how best to organize, manage and support primary care are at the heart of these questions.
Becks’ work studied a range of organizations delivering, managing or supporting primary care in the US, to interrogate the following themes:
- Management and organization of primary care systems
- Strategies to recruit and retain primary care physicians
- The impact of integration (of primary care with other community or secondary care services) on care provision
- Primary care physician representation
Becks conducted 11 case studies across a range of organizations delivering – or providing support to – primary care in the US. Four dominant themes emerged: the importance of scale in administrative efficiency, the role of hierarchy in management, transitions towards team-based care, and the importance of systematising approaches to improving primary care provider job quality. This research supports three new priorities for NHS England. 1) To better support scaled up ‘back-office’ functions in general practice via primary care networks, or integrated care systems. 2) To raise awareness of the newly-funded medical assistant role, and offer implementation support to practices moving to team-based care models. 3) To commission the development and roll-out of a national primary care staff satisfaction survey.