Improving primary and community care

Realising the neighbourhood NHS: delivering a new deal for primary care in England | The Institute of Public Policy Research

This paper provides new evidence and ideas to improve the provision of primary and community care.  It argues there should be a ‘new deal’ for general practice which should consist of:

  • creating neighbourhood care providers to deliver the ‘neighbourhood NHS’
  • offering all GPs the right to NHS employment
  • reforming new GP roles to create career progression, time to care and realistic workload
  • a radical transformation of the primary care infrastructure.

How to build effective teams in General Practice

This guide draws on insights from research, policy analysis and leadership practice to outline ways in which practices can create and sustain effective teams, as they come together to form primary care networks | The Kings Fund

The need for collaboration and communication underpins much of the guide and links to further reading and case studies to support each section are provided. The guide looks at the following questions:

  1. What are the fundamentals of effective teams?
  2. Which roles should you recruit?
  3. How can you make best use of new roles?
  4. How can teams communicate effectively?
  5. Do you need to re-design your physical space?
  6. How can you ensure supportive management and accountability?
  7. How can you work across organisations?
  8. How should you engage with your patients?
  9. How can you manage yourselves effectively?

Full document: How to build effective teams in general practice

Understanding primary care networks

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

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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

Improving primary care access out of hours

Improving access out of hours: evaluation of extended-hours primary care access hubs | The Nuffield Trust 

This report explores whether schemes aiming to increase the availability of primary care access out of hours improved the overall quality of services and patient experience in north London. Barking and Dagenham, Havering and Redbridge CCGs commissioned this report to evaluate the impact of access programmes in their areas.

Key findings

  • Most of the patients interviewed told the researchers that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
  • Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
  • Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during the research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
  • However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
  • During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
  • The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
  • Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
  • Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
  • It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.

Full report:
Improving access out of hours: Evaluation of extended-hours primary care access hubs

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

GP practices free up 3,000 extra patient appointments through Primary Care Network

GP practices in Luton have worked together to provide more than 3,000 extra appointments a year including halving the number of appointments lost due to patient non-attendance | via NHS England

As well as freeing up appointments, the Primary Care Network (PCNs) model has led to friends and family satisfaction with services being positive nine times out of ten, while complaints have fallen by 12 per cent and £50,000 has been saved.

To achieve this, the GPs made a number of changes including altering the types of healthcare professionals in the practice, offering alternative appointments where appropriate and introducing long term conditions clinics.

PCNs are one of the new national approaches unveiled in the NHS’ long term plan this week. In Luton’s PCN, groups of GP practices pool their skills and resources to provide patients with access to more health professionals including GPs, pharmacists, paramedics, physicians associates and specialist doctors.

They can treat patients for a wide range of illnesses, ensuring they see the right person from the start and freeing up the GPs to spend more time with patients who have complex needs.

Full story at NHS England

Primary mental health care

Filling the chasm: reimagining primary mental health care | Centre for Mental Health

This report explores local initiatives which bridge the gap between primary care and secondary care mental health services, supporting people have more complex needs, don’t meet secondary care thresholds, or present with multiple or medically unexplained symptoms.

centre
Image source: http://www.centreformentalhealth.org.uk

It finds that primary care services in many areas of England have developed a number of different approaches to addressing mental health needs that other services do not meet. The report describes promising approaches in eight local areas.

The report calls on NHS England to make primary mental health care a central strand of the long-term NHS plan, due to be published later this month. The NHS needs to identify effective models of primary mental health care and invest in local services to help them meet the needs of their communities. The report also calls on Health Education England to invest in the workforce for primary mental health care.

The report identified some key elements for future primary care developments:

  • Identifying the opportunities for prevention and promotion of mental health – including in the perinatal period; with children and young people; and through providing information and resources
  • Maximising social interventions for mental health – moving away from anti-depressants and therapy as the only solutions, improving awareness of community resources
  • Culture change – embracing the holistic approach – valuing social support and linking to physical health initiatives
  • Empowering the person – moving ‘from patient to person’ – enabling people to make their own decisions about what they need to focus on, addressing social factors and causes of mental health problems
  • Bridging the gap between primary and secondary care – co-locating services, employing senior staff to provide consultancy and supervision

Full report: Filling the chasm. Reimagining primary mental health care | Centre for Mental Health