The Nuffield Trust has published an evaluation report on the Primary Care Home model – a way of organising care for groups of 30,000 to 50,000 patients. Established in the UK last year, the model seeks to link staff from general practice, community-based services, hospitals, mental health services, social care and voluntary organisations to deliver joined-up care. The model was piloted in 15 rapid test sites, each of which qualified for £40,000 of start-up funding from NHS England. Since then another 170 sites have signed up.
The Trust has also published a blog by Stephanie Kumpunen on her learning from the report, and a guest blog from Dr Nav Chana from the National Association of Primary Care outlining the progress of the Primary Care Home programme.
The formative evaluation was based on reviews in 2016/17 of 13 rapid test sites’ plans and priorities for building the PCH model, and an in-depth look at the progress and early successes in three case study areas.
The report looks at how sites can make early progress with implementing and evaluating their local PCH models, examines what might stand in the way of change and offers a number of broader lessons for the NHS as a whole.
Key points raised by the evaluation included:
- Participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals, and stimulated new services and ways of working tailored to the needs of different patient groups – for example, through targeting frail patients at risk of hospital admission.
- Policy-makers must accept that these new working relationships will take time to establish, as widespread service change requires support from people at all levels and across organisational boundaries.
- Developing the PCH model needs significant investment in time, money and support to enable change: as well as the £40,000 start-up grant, all of the rapid test sites in the study channelled further money and/or professional time into the PCH. Additional funding for general practice will need to be balanced with investment in the kinds of at-scale multidisciplinary work underway in PCH sites.
- The complex external context in which PCHs are emerging – particularly with the development of Sustainability and Transformation Partnerships – could help or hinder their development. Sites will need local commissioners to buy in to the PCH vision and fund pilots of new services, which may be difficult with regional priorities restricting their clout to support enthusiastic sites.
- Good quality data – and the ability to use it – are essential for future evaluations of these models. During the evaluation, good progress had been made by the rapid test sites to select metrics and identify data but none had yet established a systematic process for tracking progress against a defined set of metrics or costs in the first six months. The lack of joined-up data between different parts of the NHS and social care could further impede progress.