I am delighted to have the opportunity to address the forthcoming “Defining Primary Care in the 21st Century” themed Primary Care Partnership Conference on the 31st March and 1st April in Croke Park. As Chair of The National Association of Primary Care (NAPC) in the UK, I will be able to draw on parallels and share insights into the work that the NAPC is doing, that seeks to address keeping patient care in the community.
There is a natural tendency, with the whole of the health and social care system under significant pressure, to attribute cause and effect on specific ‘parts’ of the system rather than how a system responds. This, in turn, leads to a focus on specific initiatives to try to solve the problem, which in turn drives a fragmented response.
The real question is how can we organise a system of care so patients get the most effective care as quickly as possible, with the fewest unnecessary contacts. This benefits patients, and the health and care services as a whole, by cutting out unnecessary activity and delivering the right care sooner, in the right setting.
The National Association of Primary’s (NAPC) Primary Care Home (PCH) programmme, is doing just this, by building on the value that primary care brings to a system of care of delivery, organised around the functions of primary care. The model recognises the importance of the GP as an expert generalist but also the role that other colleagues can play in creating a skilled team to address population health needs, demand and address the workload challenges faced within primary care and other parts of the system.
A number of emerging examples drawn from the PCH sites testing the model nationally are beginning to show benefit. Whether it’s direct access for services e.g. midwifery, physiotherapy and follow up cataract care in East Grinstead. Or, social prescribing initiatives for lifestyle related behaviours in patients with weight problems in St Austell. These initiatives are beginning to show the value of working in an integrated way across systems of care, thereby reducing demand in general practice and in some cases reducing non elective demand in hospitals as is happening at the Larwood and Bawtry test site.
What’s needed is the breaking down of silos between different providers such as GP practices, community pharmacy, community health services, social care and acute and mental health Trusts; it requires everyone in the local NHS/local authorities to look at providing care from a population perspective, rather than just that of their own service. Aligned budgetary incentives to drive the integration ‘mind set’ across health, social care, local government and the voluntary sector are key to ensuring a good outcome for the population as receivers of services and as taxpayers. The Primary Care Home Model has proved its worth at 15 Rapid Test Sites across the country, from Cornwall to Cumbria, covering more than half a million people, and is being rolled out to 100 sites covering up to five million people.
We think the experience of Primary Care Home shows the problem is a system problem, and the solution resides in bringing together local systems of care with aligned incentives.
Dr Nav Chana
Chairman – National Association of Primary Care