GPs in 50,000-patient hubs report better job satisfaction, research suggests

Almost 70% of GPs and practice staff working in 50,000 patient integration sites say the model has improved their job satisfaction, according to new research.

NAPC chair Dr Nav Chana
NAPC chair Dr Nav Chana

Early analysis of three ‘primary care home’ pilot sites published today by the National Association of Primary Care (NAPC) suggested the model is delivering a range of benefits to patients and staff.

The report comes as NHS England today said it expects practice groupings serving 30,000 to 50,000 people to become the ‘ordinary way to do business’ for general practice, and will provide funding to encourage every practice in the country to join local care networks.

Earlier this month primary care minister David Mowat told MPs general practice would develop from the current 7,500 practices to 1,500 'super hubs' serving around 40,000 patients.

General practice at scale

NAPC's primary care home model was launched as a pared-down version of NHS England's multispecialty community provider (MCP) new care model in 2015. Fifteen rapid test sites were set up with £1 per patient funding from NAPC and NHS England. The programme was expanded to 92 sites in 2016 and there have been more than 50 applications so far for the third wave.

The model is based on provision of care to defined, registered populations of 30,000 to 50,000, with integration of primary, secondary and social care services, a combined focus on personalised care and population health outcomes, and aligned clinical and financial drivers through unified population budgets and shared risks and rewards.

The new research, carried out by PA Consulting, found a range of benefits across three of the initial rapid test sites.

Improvements included £27,000 annual savings from A&E attendance reductions at the Thanet site, 330 fewer GP referrals at the Beaconsfield site, £220,000 of prescribing savings demonstrated at Larwood and Bawtry, while 67% of staff across the sites said the PCH had improved their job satisfaction.

GP access

Waiting times to see a GP improved by six days at the three sites, while 82% of staff said the project had improved the patient experience.

The research also suggested the primary care home model could help deliver sustainability and transformation plan (STP) aims of improving health and wellbeing, care and quality and financial efficiency.

It found that the model enables positive change by being provider-led, working at a ‘deliverable level’, encouraging system-wide collaboration, activating the workforce to drive change and by combining an overarching vision with bottom-up implementation.

The primary care home model is non-prescriptive, allowing local providers to design their own versions. The Beaconsfield site in Devon consists of four practices serving 32,500 patients with an enhanced care home service, multi-disciplinary urgent care team, redesigned care pathways, and is developing a virtual ward for at-risk patients and psychiatrist-led primary care mental health service.

Thanet Health in Kent is 18 practices serving 47,550 patients establishing four primary care home models as a shadow accountable care organisation with an integrated electronic patient record and acute response team to manage unwell patients outside of hospital.

Larwood and Bawtry in South Yorkshire is 2 practices serving 30,450 patients providing improved care for patients in care homes and with learning disabilities, a pharmacist-led prescribing pilot and a phone hub to improve call handling and care navigation.

NAPC chair Dr Nav Chana said: 'This report provides confidence that the primary care home model is helping to make a real and much-needed difference to patients and staff as well as easing pressures on the wider health system. It shows that it is inspiring staff to embrace and own change at a time when it’s urgently needed.'

He added: ‘We welcome NHS England’s continued commitment to transforming primary care and its push for the roll out of models like NAPC’s primary care home programme.’

NAPC president Dr James Kingsland said: 'The rapid adoption and spread of primary care home demonstrates that this is what our colleagues have always been looking to do – a vehicle to deliver change that’s quick to get up and running, empowering for staff and patients and realistic in that it grows from established list-based practice.'

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