The idea of a primary care home (PCH) was developed by the National Association of Primary Care (NPAC) in 2015 to improve integration between health and social care services across populations of between 30,000 and 50,000. The aim was to offer higher quality patient centred and personalised care.
Initially the programme began with 15 pilot sites, one of which is Larwood and Bawtry, an area that covers villages in Nottinghamshire and South Yorkshire.
The initiative has delivered some impressive results, explains Dr Steve Kell, lead GP for the Larwood and Bawtry Primary Care Home - not just in terms of patient outcomes but also staff working life.
The PCH brings together two separate practices, Larwood Health Partnership and Bawtry and Blyth Medical (which comprise seven sites in total), to work jointly for the benefit of their 35,000 patient population group.
Working together
‘This is just about people working together rather than giving up organisational identity,’ says Dr Kell, who is also the managing GP partner at Larwood Health Partnership.
'Collaboration and building a primary care team for the local population is something we were keen to explore and develop. I don’t think the old system of GPs being the gatekeeper to other services meets population need as effectively anymore. By contrast, the PCH model encapsulates the way of working we wanted to achieve.'
One of the main changes under the new model includes the creation of a monthly steering group, which brings together practice staff (GPs and nurses) with members from community health services, the local hospital, mental health services, social care, the CCG as well as from the voluntary sector and local district council to reflect that patients have wider social needs that go beyond their healthcare.
The group’s aims are to reduce bureaucracy and inefficiency, improve patient outcomes and support staff and their wellbeing, Dr Kell says.
'It’s a monthly meeting to look for opportunities to work together, problem solve and take decisions quickly so it goes beyond the contractual mechanisms. We are merely using contracts, staff and resources we have in the best way we can to serve our population so it’s a model built on relationships rather than funding.
'And we wanted to work more closely with the council so we could have input on patient’s housing needs or care home provision.'
The team at Larwood Surgery
How has patient care changed?
So, how has patient care changed? Co-locating community staff within practices has delivered significant benefits. With teams being able to talk face-to-face and communicate more easily, patient care is more joined-up and responsive.
In fact, Dr Kell says, as a result of greater team working referrals to the rapid response service halved between July 2016 and July 2017. Over a nine-month period at the start of 2016/17, hospital admissions were also cut by 120 compared with the year before, which represents a significant saving, he adds.
'We didn’t set this all up with the aim of reducing these numbers - we have just focussed on building better care. But the results have been very positive.'
The model goes beyond a purely medical focus, taking into account that patients have much broader needs. Voluntary services are also co-located within practices so patients can access services other than healthcare that can help address other major social problems.
For example, patients can be referred to a community adviser working on site who will then signpost to charity services in the area or provide advice.
'We have really improved people’s lives this way because we are helping patients to deal with issues that have a big impact on health needs,’ Dr Kell says. ‘Patients can access a range of services for problems such as domestic violence, mental health, substance misuse and loneliness and more.'
A more integrated approach also means the practice pharmacist works with the community team to ensure the quality and effectiveness of prescribing. The pharmacist has carried out a review for all care home patients, Dr Kell explains. And, over the last 12 months prescribing costs for Larwood have dropped by £250,000 - the equivalent of around 5%.
Another change is that patient calls are all now handled by a group of staff based on one site and trained to improve consistency and call handling time. There is also a bigger focus on digital practice with online services being encouraged to give patients more control of their own health.
A care navigation programme is also being implemented. 'We have invested a significant amount into a digital phone system and made WiFi available across all sites so everyone has access to the internet. On the back of that technology we are building care navigation which we hope will have a big impact.'
Improvements for staff
From a staff perspective, this new model has resulted in some big changes. Recruiting GPs has been easier, says Dr Kell.
'Because this is a new way of working in terms of ethos and culture we have had three new GPs join us, two of which have become partners. One said in their interview that they liked the new approach because it was about working as part of a team rather than being isolated in a room.'
Meanwhile, a staff survey published in March 2017 found that 87% said the PCH way of working had improved their job satisfaction and 93% felt it had improved patient outcomes.
But both practices have worked hard to ensure staff have been heavily involved in the changes and have ample opportunity to feed into the future direction and vision of this way of working.
'It’s very important that staff are engaged,' says Dr Kell. Initially, staff workshops were held to gauge how team members felt about their jobs and what improvements could be made.
Dr Kell says that it was important that GPs and managers were clear about the aims of the new PCH model and the reason for moving it to allay any staff concerns, emphasising that it was about collaboration not competition.
The next steps for the PCH includes continuing to improve communication, implementing joint training and developing a workforce strategy so the team can continue to grow and progress. The PCH is currently recruiting paramedics to work as part of the primary care team.
'We need to keep building relationships with providers,' Dr Kell says. 'This is a way of working that is here to stay now because it’s more sustainable for the future.'
Dr Kell will be speaking about his experience setting up the primary care home at the RCGP annual conference in Liverpool next week. Find more details here.
This article first appeared on GPonline's sister site Medeconomics.
