Dr Nav Chana: Collaboration can make general practice more efficient

A more efficient primary care sector could provide more services and support the Five Year Forward View, argues Dr Nav Chana. He explains how the National Association of Primary Care's new Primary Care Home model is helping to achieve this.

Dr Nav Chana, chair of the NAPC (Photo: NTI)
Dr Nav Chana, chair of the NAPC (Photo: NTI)

It’s no secret that the NHS faces growing pressure against falling budgets, but STPs are a much needed path towards reconfiguration.

They provide an opportunity to better spread the load, ensuring both funding and need for treatment can be shared more evenly across sectors, in order to tackle rising demand.

However, the few STP drafts that have been published have really put the spotlight on the primary sector’s need to improve in terms of efficiency and communication before it can take on more work from the acute sector.

This is likely due, at least in part, to historic challenges, and the infancy of primary care at scale, but the situation must change to fully realise the potential efficiency savings alluded to in the Five Year Forward View, and change is happening.

Primary Care Home

The way forward is being mapped by the NAPC, which has developed a new model for primary care, called the Primary Care Home, which enables and encourages collaboration amongst local providers.  The goal is to create close working relationships between GPs, community services, nursing homes, voluntary organisations, mental health workers and local hospitals to provide care for a registered population of between 30,000 and 50,000 people.

As things stand, general practice is often the first point of contact for patients, with the current system positioning them as the first point of contact, making referrals to specialists. However, around 25% of patient contact with GPs is unnecessary.

By building a team made up of different primary care providers, the Primary Care Home aims to cut out these unnecessary email, letter and phone transactions and better share the load across the full spectrum of primary care provision. The theory is that this will, in turn, ensure greater efficiency, affording primary care providers more time to take on work that has traditionally sat with the secondary care sector. 

How it works in practice

The Primary Care Home was launched in October 2015 with 15 rapid test sites trialling the new model. Less than a year into the programme, all 15 sites are reporting good results.

One such site, the Beacon Primary Care Home in Ivybridge, was able to employ specialists in musculoskeletal disorders and dermatology as part of its core first-contact care team in the hope of preventing one in three people from having to go to the hospital. In just under a year they’ve succeeded, with 70-80% of patients that would have previously ended up in hospital being treated by a specialist GP within two to four weeks.

The Beacon Primary Care Home has also inspired the local population to take more responsibility for their own healthcare, with one Patient Group organising an event for 250 local people to offer advice and share information about local health and fitness facilities. The event, which cost the NHS just £56, potentially saved significantly more by raising awareness of the possible alternatives to visiting a GP or hospital, from a prevention and cure perspective.

Taking on new services

This is the first step towards the future but, of course, simply integrating services is not enough to truly take the pressure off secondary care. Primary care providers will need to take on far more from hospitals, delivering increasingly specialist procedures within the primary care domain. This is possible, but as things stand too few primary care providers have the correct facilities.

Building new brick and mortar facilities would take too long, cost too much and – critically – many new facilities would only be used during peak periods. But by borrowing the acute sector’s answer to temporary capacity issues, we can utilise mobile facilities, such as those provided by Vanguard Healthcare Solutions, a strategic partner of the NAPC, to flexibly increase capacity and increase service offerings in a primary care setting.

Endoscopy procedures, for example, could be delivered in a primary care setting, but a lack of facilities and skills has prevented this in the past. As long as patient safety is carefully considered, mobile theatres on site at primary care facilities are a crucial step in resolving this issue without an unnecessary and costly commitment to permanent infrastructure.

The Primary Care Home model aims to demonstrate that it’s possible to change the way primary care services are delivered. With the use of mobile facilities, there’s no reason why low risk procedures can’t be delivered out-of-hospital, reducing pressure and, ultimately, helping patients receive care closer to their homes. 

Once primary care is ready and able to work more closely with hospitals, the future of healthcare will be more community focused and place-based – and that is undeniably a positive result for all.

  • Dr Chana is chair of the NAPC

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