In conversation with Ruth Rankine

Ruth Rankine is Director of the Primary Care Network at NHS Confederation, representing the breadth of primary care providers across England, Wales and Northern Ireland. Her work focuses on strengthening the voice of primary care at national level, shaping policy, and supporting better integration across services. She leads the Confed’s work on neighbourhood health and care closer to home.

“The Primary Care Network supports at-scale primary care; federations, super partnerships, anything beyond individual general practices,” Ruth explains. “Over the last year, we’ve also started engaging with providers from community pharmacy, optometry, and dentistry, and now have members from each sector as well as a seat on our advisory group. It’s crucial to bring all of primary care together because there are real opportunities for better integration, not just across the wider system, but within and across primary care too.”

Ruth joined us to share her reflections on emerging primary care collaboratives, the potential of Integrated Neighbourhood Teams, and what she hopes to see in the forthcoming 10-year plan for the NHS. We began by asking about how primary care collaboratives are taking shape across the country.

“Primary care collaboratives have largely developed from the ground up,” Ruth explains. “There’s been no specific national guidance, unlike for acute or mental health sectors, so it’s really been down to local leadership. What we’re seeing is huge variation, shaped by local context and need.”

In some areas, collaboratives are deeply embedded in their systems, taking on service delivery roles or working in partnership with trusts. Others focus more on being a collective voice for general practice. Some, like NENC PCC, bring together all four pillars of primary care – general practice, pharmacy, optometry and dentistry.

“What unites collaboratives is a shared purpose: strengthening primary care by working together in a way that makes sense locally,” she continues. “There’s no single model, and there doesn’t need to be. The key is creating space for primary care providers to come together, identify shared challenges, and build collaborative solutions.”

What makes collaboratives effective?

“One of the main strengths of a collaborative is the ability to act quickly and flexibly,” Ruth notes. “That agility is something we don’t always see in other parts of the NHS.”

Collaboratives can share back-office functions, manage workforce more effectively, and respond in a coordinated way, as was evident during the COVID-19 vaccination programme.

“But just as important is the strategic role they can play,” she adds. “If you’re trying to engage primary care at system level, having a single point of contact where leadership comes together is essential. That kind of clarity enables better conversations and ensures primary care has a seat at the table.”

The future of neighbourhood working

We asked Ruth what she made of the new Integrated Neighbourhood Teams (INTs) and how they might support more joined-up care at a local level.

“The idea behind INTs isn’t new,” she says. “Many places have been working this way for years to bring together GPs, nurses, social workers, mental health professionals, and others to wrap care around individuals with complex needs.”

“What’s exciting now is the opportunity to go further,” Ruth continues. “This isn’t just about coordinating NHS services. It’s about recognising that many of the factors that affect people’s health sit outside the NHS. Things like housing, isolation, poverty.”

She points to examples of place-based innovation that are making a real difference:

“Fleetwood is a great example. Dr Mark Spencer and the Fleetwood Trust have created something that genuinely reflects what the local population needs, because they’ve co-designed it with them. It’s grassroots, it’s inclusive, and it works.”

“Every neighbourhood will need its own version, but that community-powered approach should be at the heart of it.”

Looking ahead to the 10-year plan

With a new 10-year plan on the horizon, Ruth shared her hopes for how primary care will be recognised and positioned within the wider NHS.

“My hope is that the plan gives primary care the status it deserves, as an equal partner in the NHS,” she says.

“The Darzi Review gave us clear evidence for why investing in primary and community care matters. I want to see that acknowledged and built upon. Primary care has so much to offer. It’s agile, it’s innovative, and it can deliver quickly and differently, depending on what local communities need.”

“That flexibility is a strength. But for it to be fully realised, primary care needs to be treated with the respect it’s earned. The 10-year plan is a real opportunity to show that.”

Final thoughts

We ended our conversation by talking about leadership as a keystone to a thriving primary care for the future.

“Primary care leadership hasn’t been invested in in the same way that we’ve seen in other parts of the NHS, like acute chief executives, for example,” Ruth notes. “But there are some incredible people in primary care who either naturally lead or have huge potential. They just need the right support and opportunities.

“If we’re serious about meeting the ambitions in the 10-year plan, we must harness the existing, and build new, leadership capability to deliver it, clinical and non-clinical.

“The best leaders in primary care aren’t just strategic thinkers, they’re brilliant relationship-builders. They know how to bring people together, how to collaborate, how to listen. That’s the kind of leadership we need in primary care, and it’s well worth investing in.”