Team-based care at the heart of primary care home model

We are seeing a real sense of renewed energy and motivation within people working in parts of primary care – which is something I’m personally excited about as the NAPC’s primary care home programme continues to build momentum.

This was our aim at the beginning – just after the NHS Five Year Forward View was published in 2014. We wanted to reinvigorate general practice, to build on its strengths and bring together teams to work together around the needs of their community and populations.

Working with the new care models team, we looked at how we could re-energise and motivate primary care teams and the wider workforce across first contact care – including community and mental health services. With many weary with the current pressures, we wanted to reconnect them with the purpose of primary care, to re-establish the great teamwork that’s at the heart of general practice and fundamentally to make primary care more sustainable for the future.

And so, the primary care home programme was launched – initially with 15 rapid test sites to test the model. Now 18 months later, we have more than 180 primary care home sites across England, representing eight million people, 14 per cent of the population. Applications continue to come in.

The title – primary care home – stands for the home of care for a population. It’s about building an integrated care community.

One of the key aspects of the model is population health management led by highly effective unified multi-professional teams. It essentially involves proactively addressing the health and wellbeing needs of a population through segmenting the population into groups defined by a common symptom, condition or characteristic. The next crucial step is for the primary care home to target interventions for the segmented groups, and those within it, with the ultimate aim of addressing the needs of the entire population.

This is just one of four key components of the primary care home model which were derived from the learning from various approaches to developing primary care provision in the past, but with a renewed focus aligned to the principles of the NHS Five Year Forward View.

For me, as a GP, one of the most rewarding aspects of the programme has been the huge boost it’s given to staff morale. I’ve talked to a number of colleagues who were considering early retirement but are now rethinking on the basis that the style of working implicit in this model of care becomes a reality.

There are also practices that have struggled to recruit and retain community nurses but have now filled their vacancies after starting to develop their own primary care home.   

Developing a primary care home is fundamentally about building relationships. The Nuffield Trust’s evaluation published today found that, from case studies of three rapid test sites, the PCH model acted as a strong catalyst for collaboration between organisations within and outside the NHS, redefining relationships between GP staff and the wider primary community and voluntary sector workforce, often through the creation and co-location of new multidisciplinary teams.

The key to the primary care home programme’s success, I believe, lies in the fact that the shift is taking place at the grass roots rather than being imposed from the top down.

Staff are feeling much more engaged as they can see the direct benefits to patients and their community from an integrated approach to care by unified teams working together to meet their needs.

With integrated teams straddling traditional organisational boundaries, we are seeing that clinical teams can be released to do what they are trained to do.

Size is critically important – a primary care home should serve a population of between 30 and 50,000. This is the right size to develop effective multi-professional teams and the right size to deliver a sense of belonging for patients and staff.

If we address the morale issues within the workforce and staff regain satisfaction in providing care, the rest – the redesign, integration and transformation of primary care – will follow.    

Dr Nav Chana is Chair of the National Association of Primary Care. Please note that views expressed in guest blogs on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.