A tour of the primary care home

20 November 2015
 David Colin-Thomé
Long before the term federation was on the lips of every ambitious GP, the “primary care home” set out the idea of an NHS meso organisation, a generic name for primary care collectives irrespective of structure or legal form writes David Colin-Thomé.
Whether it is a federation, a locality or a network, the defining characteristic of the primary care home is a community population based organisation with its own budget which provides an alternative to current NHS hospital centricity.
The other important concept, which may have been obscured by the new commissioning regime ushered in by the reforms (initially “GP-led”, remember and only later “clinical”) is that these local organisations would provide a home not only for general medical practitioners and their teams but for all primary care independent contractors and other colleagues. It envisages GPs working with pharmacists, dentists, optometrists and their staff, community health services and social care professionals.
The primary care home could also accommodate many currently working in hospitals, in particular those responsible for long-term conditions care, for rehabilitation and reablement, and for the hospital specialists who specialise in ”office based” procedures. With modern technology such procedures are on the increase.
The model is a forerunner of the Five Year Forward View multispecialty community provider.
It has implications wider than where people go to work and who works in the next office, though these are profound enough. It has the potential to be a disruptor that drives a new approach to commissioning and a reshaping of the decades-old NHS hospital model.
Much of the current focus of commissioning is to drive quality into providers using a transactional contractual model. A population budgeted community based provider can make decisions to “make or buy” value based care for which commissioners should hold them to account. Concomitantly, much of the care currently undertaken by hospitals could be better undertaken near the patient’s home.
General medical practice’s heritage, strength and popularity with its patients come from being local to its community and offering continuity of care. These virtues must be maintained but enhanced as part of a larger organisation. Commentators have long acknowledged that general practice needs to be both small and large in its impact – small enough to play its traditional role, large enough to be clinically ambitious and financially viable.
The primary care home offers this opportunity to other organisations and individual clinicians: to offer care for the individual together with a population responsibility; to have control of resources with a transparent accountability leading to transparent autonomy.


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