Primary Care: Home or Haven?

General Election aside, for the NHS these past few weeks focus has been on the publication of Next steps on the NHS Five Year Forward View. It has dominated much of the news and demanded much of the attention of the health and care commentariat.

Slightly under the radar, two other reports caught my eye. The first is a report from the Royal College of General Practitioners (RCGP), titled Responding to the needs of patients with multimorbidity – A vision for general practice. The second is from the National Association of Primary Care (NAPC) and PA Consulting, titled Does the Primary Care Home make a difference? — Understanding the impact.

Both tell uniquely different stories, both speak to primary care — as a provider ‘movement’ — that can be a powerful agent of transformation. The RCGP report focuses on phenomena almost always observed in populations, and in these days of placed based systems of care, populations matter.

Over the past four years, Sollis has provided population health analytics support to a large number of Clinical Commissioning Groups (CCGs) across England. Working in collaboration with the world-renowned academic and research institution, Johns Hopkins University, we have run the numbers and observed the following phenomena:

  • The need for health care varies — a small percentage of people consume a large amount of resource.
  • Multi-morbidity is the norm — it is more common for people to have multiple chronic conditions than to have just one.
  • Co-morbidity impacts resource use exponentially — not in a linear way.
  • Multi-morbidity is not distributed evenly across a population and case mix varies quite significantly between GP practices.
  • Multi-morbidity, more than age, is a key driver of cost, activity and future risk, and multi-morbidity occurs across the whole adult age range.
  • The top of the ‘risk pyramid’ is not homogenous — there is not as much overlap between different risk groups as people may think.

Armed with these insights primary care providers now have access to tools and evidence that will enable them to make informed decisions on the development and implementation of new care models that best meet the health and care needs of their local populations.

Home

Which brings me back to the Primary Care Home (PCH). In the NAPC/PA Consulting report, under the heading Recommendations for next steps, there is a recognition that as the PCH programme rolls out, sites will need access to business tools that aid evaluation and help them run their businesses.

The good news here is that many of these tools do not need inventing. Many already exist, including those focused on helping primary care providers understand current workload and case mix in order that they might forecast the future needs of their local population. Modesty prevents me from naming one of them.

Traditionally these tools have been the preserve of commissioners. In the new world where the lines between purchaser and provider are at the very least blurred, these tools now need to be part of the primary care provider’s armoury.

Away from the business tools one of my big takeaways from the NAPC/PA Consulting report was the assertion that (and I quote):

“PCH activates staff to become the drivers of positive change. Staff are bought into the PCH principles and are energised and excited about their futures.”

Haven

At first sight, the link between the Primary Care Home and a holiday park company might seem tenuous at best, but humour me for a moment.

Haven, part of the Bourne Leisure Group, has a laser like focus on the key resource that drives their success — their people. They have invested significant time and energy in the development of five core values which drive their business.

The company has a beautifully simple creed… “We look after our teams first, and then let our teams look after our customers.”

The last time I looked, Haven boasted an annual turnover of circa £185 million. Investing in your employees clearly pays dividends.

I think there is something hugely important about this and it is an idea that the Primary Care Home has clearly embraced.

For customers read patients.

Primary care transformation has rightly been the focus of attention in many — if not all — of the Sustainability and Transformation Plans (STPs). It is also writ large in Next steps on the NHS Five Year Forward View. Wherever you look, primary care providers are on the march.

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