Business Clinic
PRIMARY CARE HOME MODEL – IS IT THE ANSWER?

The National Association of Primary Care has announced pilots of a new Primary Care Home model to bring comprehensive and personalised care to people in their communities. What does it mean for social care and is there a role for this sector?

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 delivery

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.

Benefits

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?

NO SHORTAGE OF PROGRAMMES FOR INTEGRATION

With Vanguards – both the multispecialty community providers and those focusing on enhanced care in care homes; health and social care integration pioneers; and now the National Association of Primary Care model, there is no shortage of programmes to encourage more integrated working.

If you’re a social care provider, the plethora of initiatives can be confusing, especially if you have more than one going on in your local area. Also, chasing them can be a diversion of time and attention.

From a systems point of view, rather than ‘chasing the model’, I’d recommend that providers start with the question, ‘what do we want services for older people, or people with disabilities, or people using mental health services to be like?’.

Then, once you’re clear in your own mind, start approaching potential partners, such as local clinical commissioning groups and GP federations, to hear their views and have conversations about how you might work together in practice.

The mechanism for this might be the National Association of Primary Care model or one of the NHS England new models of care. Or it might be none of these. And it may take time.

But the key thing is to have a vision around quality of care, and to develop a shared ambition to deliver it with others, whether they sit in primary care, allied health professions, the voluntary sector or elsewhere.

There are many examples of social care providers working successfully with primary care, keeping people out of hospital and leading healthy lives.

CMM’s March and July issues have articles on these. So now is the time to share your vision for care, and look to be a leader in your local system.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

VITAL PART OF A SYSTEM THAT NEEDS TO DEVELOP

Since the announcement of new models of care in the NHS Five Year Forward View there have been a number of different pilots and models developed. The Primary Care Home model could become an essential model within the health and social care systems.

The model detailed here outlines a vital part of the out-of-hospital system that needs to develop. That development and evolution is needed in order to serve patients better. It is also needed to avert the gathering crisis that is developing as traditional NHS systems, including GP surgeries, acute hospitals and the ambulance service, become overwhelmed.

It is well-documented that acute settings, especially for frail older people, are very dangerous and expensive. By establishing a multispecialty, community-based model such as this, it will reduce the need for older people with long-term conditions to enter the acute system unless completely necessary. The integrated and co-ordinated services should better meet their needs in a holistic way.

The phrase ‘Primary Care Home model’ in this instance is ambiguous and it could be that it evolves with the different test sites and as it is rolled-out for different regions for different populations. It could be applied to residents in care homes.

In these settings, and for this group of people, the Primary Care Home model would be able to deliver higher-complexity care, allowing more rapid discharge of older people from hospitals and also greater ‘hospital avoidance’.

As mentioned above, this would have a great impact on the lives of those who currently get caught-up in the acute system unnecessarily, and reduce the costs associated with traditional ‘bed-blocking’.

Ian R Smith Chairman, Four Seasons Health Care

PROPOSALS ARE HEADING IN THE RIGHT DIRECTION

I appreciate that ideas are forming but this proposal needs expanding. Three obvious issues arise.

Firstly, from the patient’s perspective, the biggest complaint is that they do not know who to turn to, who knows them as a person, who is co-ordinating their care.

We have all had the ‘bank experience’ – hundreds of perfectly nice, smiling people but no-one in charge and no-one to advocate. The GP did this, of sorts, but here there’s an opportunity to outline a way in which something can be achieved. For example, a named team assigned to the patient. Having yet another anonymous team, especially to older patients, is not a great advance.

Secondly, the thorny question of governance. The proposals would benefit from consideration of whether you want consensus or collaborative leadership. This goes to the heart of the historical problems as to ‘Who is in charge?’. Should health, as in the acute specialist or GP generalist, lead, or should social care?

As with the first argument, it is about the interpersonal relationships.

In the former, it’s about the patient and the system. In this case it’s between the members of the system.

I don’t think you need an answer, but a recognition that it needs to be resolved.

Finally, there is a huge opportunity around technology, building a system on paper records is not going to work.

The digital health revolution that we medics know as ‘precision or personalised medicine’ has huge opportunities here. Elderly care lends itself very well to this kind of learning healthcare system, of course delivered in a caring and personal way.

Stephen K Smith Professor of Medicine

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