The need to support more people outside acute hospitals is evident. It can release pressure on the acute care system and enable people to receive the treatment they need closer to home. There is a need and political drive for new models of care across health and social care including integrating services. The recently announced Primary Care Home model is one of a number of options.
The Primary Care Home model
The Primary Care Home model is defined as, ‘the complete clinical community meeting the health and social care needs of a registered population through a multispecialty community provider model’.
It was launched by the National Association of Primary Care (NAPC), which represents and supports the interests of all primary care professionals including general practitioners, nurses, practice staff, pharmacists, opticians and dentists. The aim of the Primary Care Home model is to support the strengthening of primary care in line with the new care models as outlined in the NHS Five Year Forward View.
Endorsed by NHS England, the new programme builds on NAPC’s Primary Care Home initiative and is tailored to meet the health and social care needs of a community of up to 50,000 people in a location, improving their health, wellbeing and care. The NAPC has developed a briefing paper and FAQs document to explore the model in more detail.
Care will be provided by ‘a complete clinical community’, an integrated workforce from hospitals, primary care, community health services, social care and the voluntary sector. It builds on the model of multispecialty community providers. These providers are already moving forward with developing local health and care services to keep people well, and bring home care, mental health and community nursing, GP services and hospitals together.
By moving a lot of care and support out of hospitals and into the community, patients will be offered more personalised, co-ordinated and responsive care nearer to their home. It is hoped that it will improve care for people with long-term conditions and patients needing rehabilitation. Specifically, those patients who don’t need to be supported in an acute environment.
The key features of the Primary Care Home model will be:
- Provision of care to a defined, registered population of between 30,000 and 50,000.
- Aligned clinical financial drivers through a unified, capitated budget with appropriate shared risks and rewards.
- An integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care.
- A combined focus on personalisation of care with improvements in population health outcomes.
Making it work
It has been designed to allow primary care, community health and social care professionals to work together with specialists to provide care out of hospital settings. However, to make the model work it will need buy-in from all health, community and social care partners including clinical commissioning groups, GPs, patient groups, local authorities, care providers and health trusts.
The business vehicle behind the clinical partnership model has a few options which could include an equity stake in the organisation. This could be through a partnership model with stakeholders being jointly incentivised. It will also require a population-based capitated budget which will require providers to achieve enhanced value.
It will require careful planning of the workforce to create a single, integrated, multidisciplinary workforce of clinical and social care professionals who are able to meet the needs of the population they will serve. The new ways of collaborative working will require roles to develop and could include cross-skilling of staff and will require change management. It will also separate out the roles of GPs and specialists who can focus their skills where they are most needed.
There will also be premises requirements, with the model championing a campus approach which will be using any existing health, social care and community premises and facilities where appropriate. There will also be a role for technology.
Expressions of interest for potential rapid test sites are due to be announced by NAPC soon and could be by the time this issue goes to print. It is intended that the test sites will work from November 2015 to March 2016, to prepare to go live from 1st April 2016.
NAPC feels that the main benefits for patients will be the single, integrated, multidisciplinary team, working to provide comprehensive and personalised care. It is hoped that by working together in this way the team are able to ensure the patients receive a consistent experience of care. It should enable services to be holistic, with staff having a common purpose and clear understanding of the role of each aspect of the care pathway.
It should also ensure that costly acute care is delivered in acute settings for those needing it. Patients requiring non-acute care will be served by the more cost-effective, community-based Primary Care Home model.
Over to the experts…
This move to create a community-based primary care home model will involve many different disciplines coming together. Vanguard sites announced in March have been moving towards this on a smaller scale and appear to be a precursor to the roll out of the Primary Care Home model. Is this model a good solution for the NHS? What is the role of social care? How can social care providers ensure they are involved from the start? If social care doesn’t become involved, will it miss its chance to be integral to such new ways of working?