Large scale general practice

Rosen, R. Kumpunen, S. Curry, N. Davies, A. Pettigrew, L. Kossarova, L. (2017) Summary booklets on lessons for large-scale general practice. | Nuffield Trust

In July 2016, the Nuffield Trust published Is bigger better? Lessons for large-scale general practice  which examined the factors affecting the evolution of general practice and its impact on quality, staff and patient experience.

The Nuffield Trust has now released four booklets which sit alongside this main report covering:

 

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New model of Primary Care provision

New report from the Nuffield Trust evaluates an initiative called the Primary Care Home (PCH) model developed by the National Association of Primary Care (NAPC).

The primary care home model was developed by the National Association of Primary Care as a response to workforce challenges, rising demand and opportunities to shape transformation in local health and care systems across England.

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Image source: nuffieldtrust.org.uk

This report from the Nufield Trust suggests that the new models of primary care provision are showing early signs of success but will need more resources and support for these models to work well on a permanent basis.

The evaluation found that participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals while also stimulating new services and ways of working, tailored to the needs of different patient groups.

It was judged to be 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.

Full report: Primary Care Home. Evaluating a new model of primary care.

Related: New primary care model needs resources, say experts | OnMedica

Socioeconomic status and geographical factors associated with active listing in primary care

Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient’s choice of practice, this choice (listing) is a key to understand the system | BMJ Open

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Objective: To explore the relationship between population and practices in a primary care system based on listing.

Conclusions: Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care.

Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare.

Full reference: Ranstad. K. et al. (2017) Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care. BMJ Open. 7:e014984.

Developing sustainable primary care

Challenges facing general practice are increasing. This comes at a time of increased patient need, high demand for services and growing challenges in retaining and recruiting clinical team members | PCC

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PCC has been supporting practices to prepare for the future by looking at ways they can become more sustainable. From our work so far, the following themes have emerged:

  • The need to ensure practices are well run, claiming appropriately and considering how the practice, as a whole, could work smarter.
  • Planning for the future –how a practice will need to change in the next three to five years and how steps towards this can start now, to achieve early wins and boost morale.

General practices are responding to the increasing demands they face in several ways. Some are merging with other like-minded practices or working with other partners in the health economy. Others are collaborating to share back office or clinical skills to enable them to manage patients and workloads most appropriately. This includes signposting to alternative local services.

Read the full overview here

UK top in primary care co-ordination according to international survey

The UK emerges as the first of 11 countries in an international survey of care co-ordination in primary care settings | The Commonwealth Fund

In a survey of health care experiences in 11 high-income countries, the rate of poor primary care coordination was 5.2 percent overall and 9.8 percent in the United States, the highest rate. Patients who have a positive, established relationship with their provider were less likely to report poor primary care coordination. Being young or having a chronic illness was associated with poor care coordination.

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Image source: The Commonwealth Fund

The dimensions of care coordination assessed for this study were:

  • access to medical records or test results;
  • receiving conflicting information;
  • use of diagnostic tests that the patient felt were unnecessary; sharing of information between primary care doctor and specialist.

The UK had the highest percentage of patients reporting no care coordination gaps within primary care.

Full results can be accessed here

 

Improving accountability in provision of new models

The National association of primary care has published Improving accountability in the provision of new models of care: winter review report. This is the latest report from the association’s quarterly meeting, which concentrated on whole population budgets and the metrics that may be used in the new care models that are prioritising primary care provision.

Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period | Nuffield Trust

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Image source: Nuffield Trust

Key Points:

  • The proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen. There has been a particular rise in the share of people who are passed to ambulances.
  • There is great variability between different areas in how likely NHS 111 is to send people to A&E or the ambulance service. This might suggest that some areas are too likely, or not likely enough, to send people to emergency services. NHS 111 is also more likely to dispatch an ambulance than to simply send people to A&E – which is the reverse of the usual pattern of NHS use. This lends credence to claims that the service is too risk-averse in some cases.
  • However, contrary to criticism that it adds to the pressure on A&E, the service overall seems to steer people away from emergency services. Patient surveys suggest as many as 8 million more people would have gone to A&E and the ambulance service over the last three years without 111. The call line also soaks up extra demand during winter, when it becomes less likely to refer people to urgent services.
  • NHS 111 still answers the vast majority of calls within a minute, and few people hang up after having to hold for more than 30 seconds. However, it has not met its target of answering 95 per cent of calls within 60 seconds for two-and-a-half years, and it seems prone to serious under-performance when calls spike after Christmas and the New Year.

Read the full report here