More GP funding should be spent on at-scale provider models, report says

More primary care funding may need to be spent on developing integrated, at-scale provider models, a health thinktank has said in an assessment of an NHS-supported pilot.

NAPC chair Dr Nav Chana (Photo: Anita Maric/News Team)
NAPC chair Dr Nav Chana (Photo: Anita Maric/News Team)

The Nuffield Trust made the recommendation in its evaluation of the primary care home (PCH) model, which is being developed by practices in more than 180 sites serving 8m patients.

However, the research was unable to assess the cost effectiveness of the model or whether it was meeting its main objectives. 

The PCH model, which brings practices together with other health and care providers to deliver services for groups of 30,000 to 50,000 patients, was set up by the National Association of Primary Care (NAPC) in 2015 backed by NHS England.

The PCH model is based on provision of care to defined, registered populations, 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 model aims to improve the health of populations, improve individual experience of care, reduce per capita costs and improve the experience of providing care for the workforce. 

The sites are CCG- or provider-led and work without the need for new contracts or structures, with priorities defined locally. 

NHS England has said PCHs could become the basis for multispecialty community providers (MCP).

Earlier this year NHS England announced financial incentives to support every practice in the country joining a network of at least 30,000 to 50,000 patients, citing PCH as a possible model. 

The Nuffield Trust analysis of 13 of the initial test sites, which received £1 per patient funding from NHS England and the NAPC, found that all sites had channelled further resources to developing the model. The researchers concluded: ‘As funds are allocated to primary care, a balance is needed between funding for individual practices and resources to support the types of multidisciplinary work at scale described.’

Improved services

The report found the sites had stimulated partnership working and developed or improved services for at least one targeted patient group, most commonly older people, strengthened multidisciplinary working and stimulated new pathways to deliver high quality care

An earlier assesment suggested an increase in job satisfaction at three PCH sites.

The Nuffied Trust report said there was evidence that one site had freed up time in general practice, while another had had positive effects in prevention and population health. Another site recorded a reduction in hospital admissions with savings up to £270,000. However, the researchers said they could not comment on cost effectiveness because the sites were not monitoring inputs. 

The researchers said that the PCH sites had only committed limited resources to evaluation and none of the sites had yet established a ‘systematic process for tracking progress against a defined set of outcome measures’. They added that good quality data and the ability to use it was were ‘essential’ for future evaluations. 

The assessment report said that developing the PCH model was likely to take ‘many years’, so it was ‘impossible at this stage’ for sites to ‘demonstrate the full benefits’ of the model ‘and to comment on whether sites were delivering against the quadruple aims’. 

Encouraging progress

NAPC chair Dr Nav Chana said: ‘This was an early evaluation at the beginning of the rapid test sites journey to develop the primary care home model and was commissioned as a guide to help with their future progress.

'With a small amount of money, the sites have made encouraging progress in a short time stimulating partnership working, leading frontline change, making a difference to patients and we've seen improvements to staff morale which is key to their future success. Testimony to this is the more than 180 sites which are now developing the model.’

Nuffield Trust’s lead author Stephanie Kumpunen said: ‘The positive early progress and enthusiasm demonstrated by the rapid test sites we examined was promising, with many people involved describing new and improved working relationships and a commitment to improving patient care.

‘Like most large-scale change, developing a fully functioning PCH will be a long and challenging journey, but our evaluation suggests staff are likely to find it rewarding to work in new ways and patients may well receive care that is better tailored to their needs. We hope that this report will offer some useful lessons and guidance as to the opportunities and barriers that may shape their progress.’

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