Primary care is coming home

20 November 2015
Good ideas have a habit of sinking without trace, but from time to time they bob back to the surface long after the search has been called off.
 
The NHS way of dealing with these returnees is usually to give them a new identity and introduce them with tautological pomp as a “new innovation”.
 
In the case of the “primary care home”, championed by Simon Stevens in a speech at a National Association of Primary Care conference in October, there was no attempt at rebranding. The idea came back looking very like the version that left its clothes on the beach before the reforms.
 
The primary care home sees groups of health professionals working together with control of its own budget set according to the size of the population. It is very similar to the multispecialty community provider (MCP) model of the Five Year Forward View but with a more user-friendly name, chosen to appeal unapologetically to those who see primary care as the locus of healthcare.
 
So if the primary care home is just another term for MCP, why do we need it? Fans of new models will be disappointed by its lack of novelty, but with the backing of the National Association of Primary Care – and the implicit endorsement of Simon Stevens – the primary care home is a branded version of a “new model” that professionals may feel more comfortable supporting.
 
While the officially sanctioned models are carefully neutral, designed to appeal to all tribes, the primary care home can afford to be more partisan - as long as it also remains inclusive.
 
Despite its homely feel, the concept smuggles in some hard truths about the way the NHS buys and delivers services. When you give capitated budgets to middle sized primary care providers, you also change the nature of commissioning. It becomes a strategic function that requires a significant transfer of responsibilities currently thought of as commissioners’ business to providers.
 

Some will say that the resurgence of the primary care home is just another example of the NHS’s seemingly endless capacity for repeating history. A more optimistic view is that we choose to study recent history the better to learn from it.
 

 

 

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