Opportunities and barriers ahead for new primary care model, research reveals

The Nuffield Trust evaluates the Primary Care Home model developed by the National Association of Primary Care, a way of organising care for groups of between 30,000 and 50,000 patients.

Press release

Published: 24/08/2017

A new way of delivering joined up primary care shows some promising signs of success, but will take time, money and strong working relationships across the NHS and social care to be effective, a new evaluation shows today. These findings come in the Nuffield Trust’s evaluation of the nascent Primary Care Home (PCH) model, a way of organising care for groups of between 30,000 and 50,000 patients.

The model has been developed by the National Association of Primary Care (NAPC), which commissioned the Nuffield Trust report. Established last year, the PCH 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 for groups of between 30,000 and 50,000 registered GP patients. 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 positive early progress and enthusiasm demonstrated by the rapid test sites we examined was promising, with many people involved describing new and improved working relationships and a commitment to improving patient care. 

Stephanie Kumpunen,  Fellow in Health Policy and lead author of the report, Nuffield Trust

The Nuffield Trust’s evaluation was based on reviews of 13 of the 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 (see note 1). However, it was too early in the scheme’s development for the Nuffield Trust to quantify impacts on patient outcomes, patient experience or use of wider health services. Instead the study – known as a formative evaluation (see note 2) – looks at how all sites can make early progress with implementing and evaluating their local PCH models, examining what might stand in the way of change and offering 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.
  • Policymakers must accept that these new working relationships will take time to establish, because 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 and competing 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.

Commenting on the study, lead author Stephanie Kumpunen said:

“Just over halfway through the implementation period of the NHS Five Year Forward View - which seeks to change the way care is delivered - improve patient outcomes and save money, it is timely to look in depth at the primary care home model.

“The positive early progress and enthusiasm demonstrated by the rapid test sites we examined was promising, with many people involved describing new and improved working relationships and a commitment to improving patient care.

“Like most large-scale change, developing a fully functioning PCH will be a long and challenging journey, but our evaluation suggests staff are likely to find it rewarding to work in new ways and patients may well receive care that is better tailored to their needs. We hope that this report will offer some useful lessons and guidance as to the opportunities and barriers that may shape their progress.”

Dr Nav Chana, NAPC Chair said: 

"This was an early evaluation at the beginning of the rapid test sites journey to develop the primary care home model and was commissioned as a guide to help with their future progress. With a small amount of money, the sites have made encouraging progress in a short time stimulating partnership working, leading frontline change, making a difference to patients and we've seen improvements to staff morale which is key to their future success. Testimony to this is the more than 180 sites which are now developing the model."

Notes to editors

  1. The three case study sites examined in the study were The Healthy East Grinstead Partnership, St Austell Healthcare, and Thanet Health CIC.
  2. A formative evaluation is an evaluation that takes place during the early implementation phases of a project, using early findings to shape the ongoing development of the project.
  3. The Nuffield Trust’s formative evaluation of the primary care home model was carried out in two phases between July 2016 and March 2017. The first phase, from July to October 2016 reviewed the 13 rapid test sites through questionnaires, telephone interviews and desk research. The second phase, from November 2016 and March 2017 took the form of in depth interviews with staff at the three case study sites, as well as the development of ongoing monitoring and evaluation approaches.
  4. Primary Care Home: Evaluating a new model of primary care is by Stephanie Kumpunen, Rebecca Rosen, Lucia Kossarova, and Chris Sherlaw-Johnson
  5. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.

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