This is the third in the trilogy of articles on the Primary Care Home from co-creator, Dr James Kingsland OBE. It builds on the first two articles published in January and March of this year.
The primary care home programme is still in the early stages of implementation and will evolve over time. Maturity and full functional delivery is expected to be achieved in different sites at different times. The programme was designed to be developed over a ten-year period from its official launch in October 2015.
This does mean that it will transcend the current political cycle – and the next. If it delivers the outcomes and ambition consistent with its design, then it will survive changes in administration, unlike so many previous reforms.
Early signs are that it will be sustainable, not least by the enthusiastic and widespread uptake of the programme already. From its inception and then the launch of 15 rapid test sites in 2016, the number of sites developing the model nationally currently stands at 191. This means that one in seven citizens in England are being served by a developing primary care home – that’s more than 8 million people.
At the current rate of adoption, the mature model and completed implementation may be accomplished sooner than first envisaged.
The primary care home is now the most extensive new care model for the reform of community based care provision within the NHS. Its core strength is that clinicians, managers and patients locally lead this programme. The clinical and patient centric thinking innately built into this model is the reason behind its rapid spread with the workforce advising ‘it’s what they’ve always wanted to do’ because they have ownership of the development and delivery of services. This ‘complete care community’ does not therefore have to be engaged or enticed into this model. Whilst the adage ‘form follows function’ is inherent in the construct, it will be important to realise an organisational form over time. Functional development using the four core principles of the model is the right place to start with a registered population of between 30,000 – 50,000 people. Benefitting from list-based practice and equipped with the evidence supporting this size of population makes the PCH a complete model and different from other ‘hub’, ‘locality’, ‘neighbourhood’ or ‘network’ developments.
The Primary Care Home is a provider of services based in a community setting, but incorporates some appropriate secondary care services and personnel and so enables primary care, community health and social care professionals to work in partnership with hospital-based specialists. A detailed understanding of the needs of the registered population (and therefore the expected volume and type of workload) will enable the creation of the right team at the outset who can then strengthen their efforts on maximising efficiency in the deployment of care resources and specifically in the ‘provide or refer’ decisions with their patients. Current outcome metrics, particularly in relation to general practice performance, may need to be discontinued in preference for PCH population outcome metrics. This is to focus on outcomes that matter to people receiving the service, reduce bureaucracy and prevent duplication of effort. With specialists involved in a more community focused service, the PCH offers the ability for these clinicians, currently working exclusively in a hospital setting, to provide some specialist care closer to (or within) a patient’s home; particularly those with a responsibility for long term condition care, rehabilitation and reablement, and surgeons who particularly specialise in ‘office based’ procedures.
The workforce model promotes opportunities to design and develop the roles of the wider health and social care team to best meet the needs of the community served. A ‘one team’ approach allows for staff to know each other as individuals and facilitates team members to focus their efforts in the most effective way consistent with their skills and competencies. Targeted use of the skills of the whole PCH team improves patient experience and outcomes, builds morale and enhances staff satisfaction.
There must be a balance between national approaches to workforce planning, which tend to be supply driven, with a more locally sensitive approach for the PCH model in order to create a workforce more suitable for local population needs. The importance of having the option to maintain an independent contractual status for those primary care clinicians wishing to be involved (including dentists, optometrists and pharmacists as well as general practitioners) is a core principle to a PCH development. Self-employment and partnership working must be an option in the contractual arrangements for PCH provision. The ability for the entire care workforce, whether health, social or managerial professionals, voluntary sector, administrators or support workers to have an equity stake and a say in how the organisation is run is also essential. Those who wish to be employed by the mature Primary Care Home have that option too. However, a mature PCH works more like a mutual organisation or society with strong social values, rather than the form of an NHS Trust.
This is a shortened version of the blog, the full version can be read here http://napc.co.uk/blog-5/
For more information on the primary care home programme, visit www.napc.co.uk