Primary care home is an engaging concept for GPs

8 February 2017

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.”

Topics & resources Briefings

Latest News

All GP surgeries to have wifi by Christmas

23 June 2017

The roll-out of NHS wifi to primary care has now moved into its second phase which will see free wifi available to both patients and staff in all GP surgeries by 31 December 2017.

CCGs have received a letter outlining funding allocation, payment details, timeframes and service standards to be achieved. Free wifi for patients will allow them access to health and social care resources, online tools and services, empowering self-care and helping them to make informed decisions about their health care. Further information about the GPIT programme can be found on the NHS England website.

Read More

Latest framework to help CCGs deliver more personalised health care

23 June 2017

NHS England has published a guide for CCGs and local authorities on the use of integrated personalised commissioning and personal health budgets. These are designed to enable a more personalised approach to people’s health and social care.

NHS England has made a commitment to ensure that 300,000 people benefit from personalised health and care through integrated personal commissioning by 2018/19, which includes 40,000 people with a personal health budget.

Read More

Pathway for children and young people with vision impairment

23 June 2017

VISION 2020 has published a pathway for children and young people with vision impairment. It is a best practice, generic pathway that requires health, social care, education and the voluntary sector to work collaboratively to meet the needs of the child or young person and their family. The pathway is designed to be applicable for all UK countries.

Read More

NICE approves new type of treatment for Crohn’s disease

22 June 2017

Following NICE recommendations, patients with Crohn’s disease will have routine NHS access to drug ustekinumab, which offers a new way of treating the condition.

Ustekinumab (also called Stelara, manufactured by Janssen) will be available for patients with moderate to severe Crohn’s disease.

It is recommended by NICE as an option for treating the disease in adults who have had little or no response, or an intolerance to existing therapies.

Crohn’s disease is an inflammatory bowel disease, and can affect any part of the digestive system. Symptoms can include stomach cramps, diarrhoea and fatigue. It is a chronic condition which means that is it lifelong.

Read More

Community pharmacy patient safety group launches new website

22 June 2017

The Community Pharmacy Patient Safety Group, which provides a forum for community pharmacy organisations to openly share and learn from each other when things go wrong, has launched a new website. The group, which was originally hosted by Pharmacy Voice, considers how learning from patient safety incidents can be applied across the pharmacy network and wider NHS.

Read More