The push towards ‘working at scale’ in primary care has gathered pace over the past year and there’s no sign it will slow down. The DH vanguard, or new care models, programme looks set to expand during the next 12 months, while it seems increasingly likely that sustainability and transformation plans (STPs) currently being developed across England will push practices towards greater collaboration and attempt to move more services out of the acute sector into primary care.
Against this backdrop, the National Association of Primary Care (NAPC) has been developing its own model of at-scale working to help bridge the gap between primary and secondary care.
Collaboration among providers
The NAPC’s model, called the Primary Care Home, enables and encourages collaboration among local providers. The goal is to create close working relationships between GPs, community services, nursing homes, voluntary organisations, mental health workers and local hospitals to provide care for a registered population of between 30,000 and 50,000 people.
Primary Care Home has similar goals to the multispecialty community provider (MCP) model that is part of NHS England’s new care models programme. However, Primary Care Home areas will see funding merged into a whole population budget and the initial pilots have focused on multidisciplinary teams, personalisation of care and improving population health outcomes.
At the moment general practice is often the first point of contact for patients. However, according to the NAPC around 25% of patient contact with GPs could be met in a more effective way.
By building a team of different primary care providers, Primary Care Home aims provide a better service first time to patients, breaking down the unnecessary barriers that have arisen over time and better share the load across the full spectrum of primary care. The theory is that this will, in turn, ensure greater efficiency, affording primary care providers more time to take on work that has traditionally sat with the secondary care sector.
Does it work in practice?
The Primary Care Home model was launched in October 2015, with 15 ‘rapid test sites’ trialling the new model. A year later, all 15 sites are reporting good results.
One such site, Larwood and Bawtry, which straddles Nottinghamshire and South Yorkshire, has made steps to provide more services at primary care level, improve working relationships across sites with a new dedicated phone system and reduce waiting time for assessments by introducing social care clinics at GP surgeries.
Dr Steve Kell, a partner at Larwood Surgery, believes the Primary Care Home has been critical in facilitating integration. ‘The model has allowed local surgeries to integrate. Not only is collaboration good for administrational efficiency and capacity, it streamlines our patients’ journeys through the NHS.
‘It doesn’t make sense to make patients wait for assessments because one local surgery is packed while another down the road has space. This model allows us to share the load and improve waiting times.’
Dr Kell believes that the Primary Care Home will bring together a range of healthcare professionals to improve choice, integration and deliver better outcomes for patients. ‘We want to remove the barriers to care,’ he says. ‘We want to free clinicians to have time to care and deliver co-ordinated, person-centred healthcare.’
His sentiment is mirrored by Maria Howdon, head of membership development at Thanet CCG in Kent, another area which has been working under the Primary Care Home model.
‘There are a lot of challenges in caring for a diverse population such as Thanet’s,' she says. 'Working together, local healthcare professionals have formed a Primary Care Home in Margate, implemented an integrated IT system and care record across the health economy and developed integrated teams including an acute response team.
‘By doing this, we’re improving local health and wellbeing and quality, along with achieving efficiencies. The Primary Care Home model basically wraps services around the population with the ultimate aim of delivering one service, provided by one team, with one budget.
‘In the future we expect tighter integration and hope to bridge the gap between primary and secondary care.’
Bridging the gap
The Beacon Primary Care Home in Ivybridge, Devon is working to bridge this gap between primary and secondary care. It was able to employ specialists in musculoskeletal disorders and dermatology as part of its first-contact care team with the aim of preventing one in three people from having to go to the hospital.
In just under a year, 70-80% of patients who would have previously attended hospital are instead treated by a specialist GP in primary care within two to four weeks.
However, simply integrating services is not enough to truly take the pressure off secondary care. Early indications suggest that STPs will be expecting primary care providers to take on far more from hospitals, delivering increasingly specialist procedures within the primary care. However, infrastructure could prove to be a major barrier, with few primary care buildings having the space or appropriate facilities to take on such work.
Building extra space will take a long time, involve huge costs and may only be used during peak periods. The NAPC supports exploring other options that can be just as effective in meeting these needs, including the use of mobile facilities.
Secondary care is already well acquainted with flexible capacity solutions, making use of mobile facilities to increase space at times of need. In the future, the Primary Care Home may make use of this technique to flexibly increase capacity and increase service offerings in a primary care setting.
Endoscopy procedures, for example, could be delivered in primary care, but a lack of facilities and skills has prevented this in the past. As long as patient safety is carefully considered, mobile theatres on site at primary care facilities could be the crucial step in resolving this issue without an unnecessary and costly commitment to permanent infrastructure.
Mobile facilities are already widely used to address capacity issues at hospitals in the UK. Vanguard Healthcare Solutions, a strategic partner of the NAPC, provides mobile theatres to support hospitals in tackling waiting time backlogs and increasing capacity at times of high-demand or during refurbishments.
‘Rarely do primary care facilities have the necessary clinical environment for all but the most basic of procedures,’ says Steve Peak, director of Vanguard Healthcare Solutions. ‘Mobile facilities can offer this. The facilities need only appear at the site for as long as high levels of demand exist. They could even be moved across multiple sites within the same primary care home or vanguard area.
‘Of course, special consideration has to go into patient safety,’ Mr Peak adds. ‘Just providing high-tech facilities does not mean specialist procedures can immediately be delivered in a primary care.’
John Pope, NAPC chief executive, says, ‘Primary care providers will have to carefully consider which services can be safely delivered in a primary care setting, which patients are suitable for such treatments and who is capable of delivering the service. Flexible specialist facilities are only one part of the equation, promoting a safe service in a more local setting requires detailed planning to ensure they deliver the right care, in the right place at the right time.’
It remains to be seen whether more services can realistically be delivered in primary care, but the STPs that have so far been published suggest that this is the way things are heading in many parts of England. Greater collaboration between general practice and other parts of the NHS and social care will be vital to delivering this and the Primary Care Home model seems to be making progress in facilitating this.
- For more information about Primary Care Home click here