An early evaluation of the primary care home (PCH) model, which encourages GPs to work collaboratively to provide care to groups of up to 50,000 patients, shows signs of success but will need more resources to continue into the long term.
The PCH model is a novel approach to primary care that involves GP practices collaborating with other healthcare professionals – including in mental health trusts, hospitals, social care and the voluntary sector.
Following its launch two years ago, the model has been evaluated by the healthcare charity the Nuffield Trust. The Trust reviewed 13 of the initial pilot sites and three in-depth case study areas (The Healthy East Grinstead Partnership, St Austell Healthcare, and Thanet Health CIC), focusing on facilitators and barriers to progress.
Although the evaluation concluded that PCH sites have made good progress, it said it will take many years before they are able to deliver the model in full.
Positively, the evaluation found that taking part in the programme had strengthened working relationships between GPs and other healthcare professionals.
The Trust said that progress was catalysed thanks to a ‘shared history of working together’ among GPs and hard-working, multi-organisation teams.
The scheme also led to new ways of working tailored to particular patient groups, for example frail patients at risk of hospital admission.
The integrated workforce is intended to provide care to between 30,000 and 50,000 people and was launched in England in 2015.
The NHS initially chose 15 test sites and has now expanded to over 170 sites across the country, serving over 7 million patients. Each site received £40,000 in start-up funding from NHS England.
However, the evaluation also said that establishing new working relationships will take time and requires support from people ‘at all levels and across organisational boundaries’.
Funding was also an issue. The Nuffield Trust found that even with the £40,000 grant, all of the test sites put extra money and/or time into the model.
The Trust therefore said that additional funding for general practice must be ‘balanced with investment in the kinds of at-scale multidisciplinary work underway in PCH sites.’
Indeed, many sites described concerns about obtaining longer term funding to maintain their work, especially if they couldn’t achieve buy-in from local commissioners.
The report also emphasised the importance of a systematic method for tracking progress, suggesting that a lack of unified data between different parts of the NHS could hinder progress.
Although it was judged too early to assess impacts on patient outcomes, report author Stephanie Kumpunen said the evaluation is promising: ‘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.’
Dr Nav Chana, Chair of the National Association of Primary Care (which first proposed the PCH model), added: ‘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.’
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