Understanding primary care networks

Understanding primary care networks: context, benefits and risks |  The Health Foundation

cohesion-454881_1920.jpg

This briefing places Primary Care Networks (PCNs)  in the context of previous changes to general practice funding and contracting. It examines the rationale for networks, explores relevant evidence and draws out intended benefits and possible risks for the future of PCNs.

Key points
  • From 1 July 2019, all patients in England will be covered by a primary care network (PCN) – the most significant reform to general practice in England in a generation.
  • PCNs should help to integrate primary care with secondary and community services, and bridge a gap between general practice and emerging Integrated Care Systems.
  • Since January 2019, practices have been organising themselves into local networks to provide care at greater scale by sharing staff and some of their funding.
  • While PCNs offer huge potential to integrate care and improve services, there is a risk that the speed of implementation will undermine the best intentions of the policy.

Full briefing: Understanding primary care networks . Context, benefits and risks

Additional link: NHS England press release | NHS England blog

The primary care network handbook

This handbook offers options to groups of practices looking to establish a primary care network (PCN) British Medical Association (BMA)

PCNs are groups of general practices working closely together, with other primary and community care staff and health and care organisations, providing integrated services to their local populations. The BMA have created a handbook which provides advice and offers options to groups of practices looking to establish a PCN.

pcn handbook
Image source: http://www.bma.org.uk

It includes detailed guidance on

  • Governance structures
  • Internal governance and decision making
  • Potential PCN structures and employment options
  • PCN funding
  • PCN future workforce options

Full document: The primary care network handbook

Further detail: Primary Care Networks (PCNs) | BMA

Understanding new models of integrated care

Integrated care is not quick, or cheap, but new systematic review finds sufficient evidence that it is a goal worth pursuing 

The National Institute for Health Research (NIHR) has published Ways of integrating care that better coordinate services may benefit patients. This systematic review, part of the NIHR Signal series, looks at international literature to understand how new care models may affect patients, providers and systems. It includes a qualitative review of attitudes, barriers and enablers of integration and finds new integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs.

Baxter S, Johnson M, Chambers D et al. Understanding new models of integrated care in developed countries: a systematic review. Health Service Delivery Research. 2018;6(29).

Integrated care teams: impact on hospital use

The impact of integrated care teams on hospital use in North East Hampshire and Farnham | The Health Foundation

This briefing examines the early effects on hospital use of introducing multidisciplinary integrated care teams (ICTs) in North East Hampshire and Farnham.  There is evidence to suggest that the value of ICTs might lie in their potential to improve patients’ health, health confidence, experience of care and quality of life rather than reducing emergency hospital use.

Full briefing available here

The impact of integrated care teams on hospital use in North East Hampshire and Farnham

Health Foundation

This briefing examines the early effects on hospital use of introducing multidisciplinary integrated care teams (ICTs) in North East Hampshire and Farnham (NEHF). It presents the findings of an evaluation conducted by the Improvement Analytics Unit, a partnership between NHS England and the Health Foundation.

  • The analysis shows that during the first 23 months of the programme’s implementation, patients referred to the ICTs attended A&E more frequently, and were admitted as an emergency more often, than the control group. This may be because the ICTs identified urgent unmet need amongst their patients or it may be that more time was needed for the benefits of ICTs on hospital use to be seen.
  • In conclusion, a reduction in emergency hospital use may not be an appropriate objective for these type of multidisciplinary teams, at least in their early stages. Reducing emergency hospital use was only one of the objectives for ICTs in NEHF.
  • There is evidence to suggest that the value of ICTs might lie in their potential to improve patients’ health, health confidence, experience of care and quality of life.

A year of integrated care systems

A year of integrated care systems: reviewing the journey so far | Kings Fund

integration
Image source: http://www.kingsfund.org.uk

The aim of this study was to understand how Integrated Care Systems (ICSs) are developing, and identify emerging lessons for local systems and national policy-makers.  72 interviews were conducted with NHS and local government leaders and other stakeholders to examine progress in eight of the first ICSs.

Although ICSs have only been in operation for a year, the report found encouraging signs of progress. The evidence reported shows that partner organisations and their leaders are working more collaboratively to manage performance and finances across a system in a way that was not happening previously.

Evidence of tangible improvements in services and outcomes is limited to date, but this is to be expected given the brief time ICSs have been in existence. This must be a key priority for all ICSs going forward. The report found broad consensus that the ICS model has real potential to bring about improvements in health and care, and to place services on a sustainable footing.

Full report: A year of integrated care systems: reviewing the journey so far

 

Achieving the Provision of Integrated Care

This report traces the development and impact of integrated care to date, highlights some examples of successful practice and draws out the key lessons for later-adopters |  National Association of Primary Care

This report suggests that a number of of factors – ageing populations, an increased prevalence of multiple chronic disease and rising expectations of what health care and technology can offer –  combined with limited human and financial resources, have placed health  systems under intolerable and unsustainable strain.

achieving
Image source: http://napc.co.uk

Integrated Care Systems, where health providers collaborate with other community  stakeholders to prevent ill health, provide more comprehensive care closer to home, keep people out of hospital and reduce costs, is seen as the antidote to these problems. This approach is now spreading around the world, taking many different forms from country to country.

This report of a two-day symposium attended by health experts from the UK, USA and Ireland, traces the development and impact of integrated care to date, highlights some examples of successful practice and draws out the key lessons for later-adopters.

Full report:

Achieving the Provision of Integrated Care:  Exploring the development and successful
implementation internationally of new models of integrated care

 

The health and social care interface

The health and social care interface | National Audit Office

There is widespread consensus among health and social care professionals, the NHS and policy-makers in government that the changing needs of the population require changes to the way health and social care services are organised and delivered.

This ‘think piece’ highlights the barriers that prevent health and social care services working together effectively, examples of joint working in a ‘whole system’ sense and the move towards services centred on the needs of the individual. The report aims to inform the ongoing debate about the future of health and social care in England. It anticipates the upcoming green paper on the future funding of adult social care, and the planned 2019 Spending Review, which will set out the funding needs of both local government and the NHS.

The report presents and discusses 16 challenges to improved joint working. It also highlights some of the work being carried out nationally and locally to overcome these challenges and the progress that has been made.

Report – The health and social care interface

Press release – The health and social care interface

Developing new care models through NHS vanguards

The vanguard programme, one of NHS England’s attempts to better meet patients’ needs and deliver savings by developing new care models to integrate health and social care services, has not delivered the depth and scale of transformed services it aimed for at the beginning of the programme, according to this report by the National Audit Office.

A key objective of the programme was to design new care models that could be quickly replicated across England. NHS England selected 50 sites to act as ‘vanguards’ which might entail, for example, joining up GP, hospital and community and mental health services in an integrated network or single organisation in one area to improve healthcare for patients.

NHS England’s early planning assumption was £2.2 billion of funding for new care models between 2016-17 and 2020-21, but it used much of the funding to reduce deficits faced by hospitals. Actual direct funding of vanguards was £329 million over three years from 2015-16, with another £60 million spent by NHS England on central support for vanguards. Consequently, with less funding for transformation, the original intention to expand the programme was not realised.

Despite not meeting its original intention to expand the models across the country, vanguards have made progress in developing new care models. NHS England forecasts that vanguards will make net savings. As at April 2018, it estimated that vanguards would secure £324 million net savings annually by 2020-21, which is 90% of the £360 million that had been expected.

Full report:  Developing new care models through NHS vanguards

See also: National Audit Office press release

Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

Kings Fund, 20th February 2018

NHS England has recently changed the name of accountable care systems to integrated care systems, which describes more accurately the work being done in the 10 areas of England operating in this way. Our updated long read looks at work under way in these systems and at NHS England’s proposals for an accountable care organisation contract.