What is primary care home? Part 1

What is primary care home? Part 1

Dr James Kingsland, NAPC President

The primary care home (PCH) model was created to supply solutions to the challenges of providing care to the diverse societal needs within the UK in the 21st century.

It doesn’t do what is says on the tin. It’s not the best title, it’s not a care home and it’s not confined to a tin.

However it is about primary care, an often-misunderstood sector, even within the NHS. Primary care is both a level in a health system (its form) and a strategy or philosophy for organising approaches to care (its function).

Effective primary care has four central features:

  1. A person’s first point of contact with the health and social care system.
  2. A person-centred (holistic) approach, rather than disease-focused to continuous lifetime care.
  3. A comprehensive set of services, delivered by multi-professional teams with a focus on population health needs.
  4. The co-ordination and integration of care in partnership with patients and providers.

Primary care is therefore that first level which provides entry into a health system for all new needs and problems. It provides person-focused (not disease-oriented) care over time for all but very uncommon conditions, and coordinates or integrates care provided in other sectors.

It is where the majority of a population’s preventative and curative health needs, health promotion and care monitoring are satisfied. Primary Care provision is universally accessible, comprehensive and community based and is supplied by a team of professionals accountable for addressing a large majority of both personal and a population’s health needs.

These services are delivered in a sustained partnership with patients and informal caregivers, in the context of family and community, and play a central role in the overall coordination and continuity of people’s care. If we get this right, and the national implementation is consistent with the described model, we may just finally, and exceptionally, describe transformation in the NHS.

The PCH model answers the question about the functionality of the current NHS institutions. They need revision and adaptation in order to supply care that mirrors the demand of today’s society.

This is a paradigm shift.

A new comprehensive health and care provider is created in the community. The Primary Care Home.
No more attempts at trying to create workable partnerships through the integration of disparate organisations who often have different commissions, governance and incentives.

The mature PCH incorporates one multi specialty team working together in one organisation with one budget, for a population defined by patient choice through registration with that PCH.

One system. One budget.

At last, a realisation and acceptance that our NHS is sustained and thrives on list-based practice. And size really does matter after all. List-based practice has slowly but surely been moving towards an optimum size. A PCH accelerates this evolution. The best evidence and experience of delivering the balance between personalised care and better prevention of people becoming ill-at-ease (dis-eased in Latin) through population health management is embedded within the construct of a PCH, leading to the model population size of between 30,000 and 50,000. A one-team approach with a fully integrated workforce, who all have the opportunity of an equity stake in their organisation, is vital to address the long standing NHS productivity challenge.

The PCH contractor model builds on an understanding of what improves staff morale and therefore retention, stimulates new recruitment, and empowers them to work efficiently based on the needs of their patients, not the contract that an employing institution gives them. Mutuality has always been a strength in the primary care sector.

The alignment of clinical decisions and resource consequences (at the core of the Health and Social Care Act 2012) has often been misinterpreted. Remarkable changes in daily activity and resource deployment, at the point at which NHS money starts to flow through the system, becomes the responsibility of the teams that do the work. This changes behaviour and delivers efficiency – something the NHS always struggles to achieve.

In this way access to the right care at the first point of contact will be improved and waiting times for care services reduced.

A citizen can usually get their car repaired within one hour of breakdown; but currently a mental health breakdown may take 18 weeks before it can be assessed. Is this acceptable? The PCH provides rapid breakdown recovery.

The very nature of this provider service means that incentives are aligned to prevent unnecessary hospital admissions, reduce length of stay in hospital, facilitate early discharge and prevent re-admissions. The PCH is designed to improve urgent care provision and stop inappropriate use of accident and emergency services. It navigates people through to first contact care that is able to complete that episode of care within one team and one organisation. No unnecessary transactions and the utilisation of a single integrated care record.

Care from cradle to grave, long term condition management, mental health services, population health management, social care support, urgent care provision are all provided by a single PCH…much like the unsupported, often ill-equipped and over-stretched general practice tries its best to do presently.

We have one last attempt at solving the quality and productivity NHS exam question. The answer lies in the community, not in hospital. The PCH model benefits from a strong organisational memory, an evidence base and was created and more importantly supported by clinicians.

The PCH does so much more than an idiomatic phrase about a tin.

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