Since the release of the Five Year Forward View (FYFV) in October 2014, there has been much debate and discussion about the development of new service models in the community, including multi-specialty community providers (MCPs) and primary and acute care systems (PACS).
In the refresh of the FYFV published in March 20171, there was recognition of the achievements so far and the remaining challenges. A new service model was mentioned, Primary Care Home (PCH), one which is gathering much notice and success.
The concept was created by the National Association of Primary Care (NAPC) and is based on a GP population of between 30,000 to 50,000 residents.
Services are designed around the needs of the population in a way that makes most sense to the residents and takes into account efficiency and productivity. For example, if there are high levels of attendance at A&E within the population that are considered inappropriate, the PCH determines how to address this, for example, by offering a twice-daily walk-in clinic at the GP surgery for minor illnesses and injuries.
I visited a PCH earlier this month, where I was greatly impressed by the simplicity, the no-nonsense approach of the model, the impact it has made on the health and wellbeing of the local population, and its financial savings. They had reduced their annual pharmacy bill by 5% (£229K), attributed to the employment of a pharmacist within the PCH.
The Larwood and Bawtree practice in Worksop, Nottinghamshire has been supported to make changes to its services by NAPC and NHS England. Dr Steve Kell is a passionate and committed GP who has created a ‘joyful team’, where local services gather monthly around the PCH table to create solutions – with representatives from social services, voluntary sector and district general hospital.2
Partners in the development of the PCH include equally passionate and committed colleagues such as district nursing manager Andrew Bartram and lead practice nurse Stephanie Savage. Both had positive stories to tell about working together as one nursing team in the PCH. While they don’t share the same employer, the co-location and the sense of a team with a shared purpose was tangible. With more than 10% of the population of England now served by a PCH, this is proving to be a sustainable model for the future.
DRCrystal Oldman is chief executive of the Queen's Nursing Institute (QNI)