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New primary care model needs resources, say experts

Primary Care Home model shows promise

Adrian O'Dowd

Thursday, 24 August 2017

GPs working in new models of primary care provision are showing early signs of success but will need more resources and support for these models to work well on a permanent basis, experts have concluded.

Health think tank the Nuffield Trust has today published a report* after evaluating an initiative called the Primary Care Home (PCH) model developed by the National Association of Primary Care (NAPC) as a way of organising care for specific patient population sizes.

The model was established last year, seeking to link staff from general practice, community based services, hospitals, mental health services, social care and voluntary organisations to deliver joined-up care for groups of between 30,000 and 50,000 registered GP patients.

It was piloted in 15 rapid test sites, each of which qualified for £40,000 of start-up funding from NHS England. Since then, another 170 sites have signed up.

The Nuffield Trust’s evaluation, which was commissioned by the NAPC, was based on reviews of 13 of the rapid test sites’ plans and priorities for building the PCH model and an in-depth look at the progress and early successes in three case study areas – The Healthy East Grinstead Partnership, St Austell Healthcare, and Thanet Health CIC.

The researchers found that the model showed some promising signs of success, but would need time, money and strong working relationships across the NHS and social care to be effective.

It was judged to be too early in the scheme’s development for the Nuffield Trust to quantify impacts on patient outcomes, patient experience or use of wider health services.

They found that participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals while also stimulating new services and ways of working, tailored to the needs of different patient groups, such as targeting frail patients at risk of hospital admission.

Developing the PCH model needed significant investment in time, money and support to enable change, they argued, saying that in addition to the £40,000 start-up grant, all of the rapid test sites in the study had channelled more money and/or professional time into the PCH.

“National policy-makers and the wider NHS may need to balance additional general practice funding for individual practices with investment in resources to support the types of multidisciplinary work at scale described in this report,” they said.

They urged local commissioners in Sustainability and Transformation Partnerships (STPs) to buy in to the PCH model vision and fund pilots of new services.

Lead author Stephanie Kumpunen, fellow in health policy at the Nuffield Trust, said: “The positive early progress and enthusiasm demonstrated by the rapid test sites we examined was promising, with many people involved describing new and improved working relationships and a commitment to improving patient care.

“Like most large-scale change, developing a fully functioning PCH will be a long and challenging journey, but our evaluation suggests staff are likely to find it rewarding to work in new ways and patients may well receive care that is better tailored to their needs.”

Dr Nav Chana, NAPC chair said: “With a small amount of money, the sites have made encouraging progress in a short time stimulating partnership working, leading frontline change, making a difference to patients and we've seen improvements to staff morale which is key to their future success.”

* Kumpunen S, Rosen R, Kossarova L, Sherlaw-Johnson C. Primary Care Home: evaluating a new model of primary care research report. Nuffield Trust, August 2017.

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