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Primary care home is an engaging concept for GPs
The long search for a healthcare model that engages GP practices while delivering efficiencies, integration and personalisation has alighted on the primary care home.
Developed and championed by the National Association for Primary Care (NAPC), the primary care home (PCH) approach has the benefit of being seen to have emerged from within the sector itself. The importance of that cannot be over-stated for practices and primary care leaders nervous about some aspects of the new care models championed by NHS England since publication of the Five Year Forward View.
Serving populations of 30,000-50,000, the PCH is also seen as potentially providing building blocks for at least one of those models, the multispeciality community provider (MCP). Working at this scale, supporters argue, ensures everyone within the team knows everyone else and the patient has a more consistent experience of care, similar to having a named GP.
Jonathan Griffiths, a GP in Winsford,Cheshire and chair of Vale Royal Clinical Commissioning Group (CCG), says: “I think there is an appeal to primary care home as GPs can see how this aligns to patient-centred care. It also enables GPs to be involved and to drive the agenda.”
Just over a year ago, Griffiths’ practice joined the other four in the town to successfully bid for NAPC support in testing out PCH as the Winsford Partnership.
At that time the practices acknowledged that “the current complex, piecemeal systems of providing services have not fully met the needs” of patients.
They signed up to developing an integrated multi-disciplinary team that could provide seamless, comprehensive and personalised care to individuals.
Another Winsford GP and Vale Royal CCG board member, Jean Jenkins, says: “The five practices in the town had a combined list of 33,000 patients and we were already working together on a nursing homes project so when NAPC offered some limited additional resources we put in a bid. We had been through the hard work of getting practices working together and we were already on a much better footing than a few years previously.”
Some of the resulting innovations reflect NAPC’s hopes for its model in terms of workforce and service redesign. They have encouraged partnerships between primary care, community health and social care professionals and the third sector to deliver out of hospital care.
Inevitably, talk initially focused on structures but Jenkins says they quickly realised this could be a time-consuming distraction.
“One of the early considerations was whether we merge into one big practice. We decided it was better just to work together and see how it evolves rather than spending 12 months on a merger. The hope is the model will emerge naturally over time through working together.”
Instead the practices identified the measures they could do quickly. These included two practices employing physiotherapists – transforming the musculoskeletal pathway for local people – and the siting of pharmacists in three of the practices. Reception staff are also being trained to better signpost patients to the appropriate healthcare professional or service.
One practice is also developing the diabetes pathway to share with all the practices.
“We talked to the other practices in Vale Royal, the CCG itself and our community, acute and mental health providers and then used the NAPC money to put some structure around what we were already doing,” Jenkins says.
With all Winsford’s practices signed up, the new approach boosted opportunities for public and population health activities across the town.
Griffiths says: “We were working with the then mayor and the town council and that was really positive, creating a buzz. Last February we had a wellbeing week which was planned before we started the primary care home. We are making this an annual event, this year focusing on cancer survival where we are an outlier. We are using this theme to build patient resilience and to see what we can get people in the town doing in terms of managing their own health.”
Jenkins and Griffiths say it is too early to judge the impact of the model locally against their goals of improved access and patient satisfaction and increasing the range and effectiveness of locally based services.
However, the Winsford Partnership, Vale Royal CCG and the neighbouring South Cheshire CCG secured further support for locality working in central Cheshire as part of NAPC’s scaling up of the programme. All practices in central Cheshire are now part of locality working to some extent, with the hope that they will eventually form an accountable care organisation.
Jenkins says: “The CCG does see it as the delivery of what people talked about as an MCP."
Griffiths adds: “If you are looking at accountable care I think [the primary and acute care system model] is a problem as the management structure suggests local hospitals might take over primary care. MCP is harder because you have got to bring GPs together and coordinate at the community level – the primary care home has the ability to do exactly that.”
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