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Does the primary care home make a difference?: Understanding its impact

This report presents the key findings from an assessment of three Primary Care Home rapid test sites. These demonstrate that a wide range of financial and nonfinancial benefits can be released, with positive impacts at local and STP level.

1.1 Context

The NHS needs to change radically in order to meet the needs and expectations of people in the 21st century.

Sustainability and transformation plans (STPs) are proposals that set out the future shape of health and social care services in a defined geographical area. The STPs are tasked with addressing the “triple aim” - improved health and wellbeing, transformed quality of care delivery, and sustainable finances. To achieve this, existing services need to change and new models of care are called for.

A new model of primary care and broader primary care transformation is needed to achieve these aims. As it stands, primary care is cost effective, trusted by patients and performs an essential role in coordinating care for people outside of hospital. Because of this success, primary care will be expected to offer more capacity, to provide enhanced services, and to work with additional health partners in the future.

Historically, primary care transformation initiatives at scale have struggled to achieve the intended aims. There are a range of reasons why this has been the case – change has often been imposed upon providers, GPs have been asked to give up some (or all) of their sovereignty over their practices, and there has been insufficient support to drive through this change.

1.2 Primary Care Home

In response, the National Association of Primary Care (NAPC) has developed the Primary Care Home (PCH) model, based on four defining characteristics:

  • Ÿ Provision of care to a defined, registered population of between 30,000 and 50,000;
  • Ÿ An integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care inclusive of patients and the voluntary sector;
  • Ÿ A combined focus on personalisation of care with improvements in population health outcomes; and
  • Ÿ Aligned clinical and financial drivers through a unified, whole population budget with appropriate shared risks and rewards.

The PCH shares some of the features of the new multi-speciality community provider model though is flexible enough to be considered as a standalone unit or as a foundation for other at scale models of care.

The PCH model was formally launched at the NAPC annual conference in October 2015. After receiving 67 applications, 15 rapid test sites were selected in December 2015 to pilot the model.

These sites are now putting the PCH model in to practice and making rapid progress in developing and rolling out plans to transform healthcare delivery for their local population. There are now a total of 92 sites as part of the NAPC’s Community of Practice with more than 50 additional sites applying to come on board soon. It is therefore timely to consider the benefits that the model can realise, and to explore the characteristics of the model that enable this change.

1.3 Summary of key findings

We worked with three rapid test sites - Beacon Medical Group (Plymouth), Thanet Health Community Interest Company (Thanet) and Larwood & Bawtry practices (South Yorkshire).

These sites have used the PCH model differently to address the priorities of their local populations. Our work focussed on identifying the initiatives they had undertaken as part of the PCH, and to analyse data to understand the impact of these initiatives. Wherever possible, these findings were validated with external data sources.

A summary of the most impactful findings from across these sites demonstrate the range of financial and non-financial benefits that PCH can drive. These findings also point to the PCH being a model through which STPs can work towards their broader goals in the form of the “triple aim”. This includes quantifiable financial benefits realised from reducing non-elective attendances, elective admissions and prescribing costs.