Transforming primary care to deliver integrated services

Transforming primary care: Man floating away with a balloon shaped like a light bulb

Steve How and Oli Hudson explore Primary Care Networks, and their role in bringing together GP practices to help deliver integrated services.

GP practices have been urged to unite in new networks that will bring significant changes to the way primary care services are designed and delivered, under a new contract that begins in July.

Primary Care Networks (PCNs), which are each designed to serve 30,000 to 50,000 people, will see groups of GP practices collaborating locally with community services, social care and other health and care service providers.

A total of £1.8bn of funding has been earmarked to support PCNs and this money will come from Directed Enhanced Service (DES) payments, which are an extension of the core GP contract. To qualify for a slice of the funding, GP practices are required to join PCNs by June.

 

How will PCNs operate?

PCNs are building blocks for the Integrated Care Systems (ICSs), which are expected to cover the country by April 2021 and will serve populations of one to three million people. PCNs will help the NHS to deliver on one of its key priorities: to move care out of hospitals and into community settings, where possible.

Consequently, in addition to providing core GP services, PCNs will also deliver new services linked to NHS Long Term Plan priorities. Five of the new services will start by April 2020, namely:

  • structured medication reviews
  • enhanced health in care homes
  • anticipatory care (with community services)
  • personalised care and
  • supporting early cancer diagnosis.

The remaining two: cardiovascular disease case-finding and locally agreed action to tackle inequalities – will start by 2021.

Seven workstreams, which are part of ICSs, will be layered on top of the DES-funded services, namely:

  • self-care and planned care
  • long-term conditions
  • frailty and end-of-life care
  • maternity and family
  • mental health
  • on the day care (emergency care) and
  • cancer.

 

Multi-disciplinary teams

In addition to GPs, PCNs will encompass clinical pharmacists, physician associates, first contact physiotherapists, community paramedics and social prescribing link workers. These staff will work across practices as part of a ‘network contract’ for the seven new enhanced services and help to free up GPs to focus more on patients with complex needs.

Multi-disciplinary teams in PCNs will also be instrumental in helping the NHS to deliver on its ambitions in key disease areas highlighted in the NHS Long Term Plan, such as respiratory conditions. The NHS Long Term Plan states that hospital admissions for lung disease have risen over the past seven years at three times the rate of all admissions generally and remain a major factor in winter pressures faced by the NHS.

PCNs will help to tackle lung disease in a variety of ways. For example, pharmacists will conduct medication reviews and promote self-care by educating patients. This will include advising on the use of inhalers since, according to the NHS, 90% of people use their inhaler incorrectly. PCNs will also support the uptake of ‘new smart inhalers’, as clinically indicated.

Engaging with PCNs

It will, of course, be important for the pharmaceutical industry to follow the progress of PCNs as they take shape across England and to map the new customers who will be emerging. Industry also needs to map the new customers who will be working in ICSs and Integrated Care Partnerships (ICPs) which will serve populations of approximately 500,000 and will sit  between ICSs and PCNs in the new integrated care hierarchy.

To engage with PCNs, the pharmaceutical industry must also understand how these organisations will be incentivised and measured. For example, all networks will have access to a new ‘shared savings scheme’ tied to reductions in hospital activity, such as accident and emergency attendances, delayed discharges and avoidable outpatient visits.

A PCN dashboard will be among the new initiatives for measuring performance. It will set out progress on network metrics covering population health, urgent and anticipatory care, prescribing and hospital use. Metrics for the seven new workstreams, which are part of ICSs, will also be on the dashboard.

To help PCNs deliver on their objectives, the pharmaceutical industry should consider how its products can deliver wider benefits across the whole care pathway, particularly with regards to keeping people out of hospital where possible. Industry also needs to consider the implications of the wider determinants of health, such as diet and fitness, since population health is a key priority for PCNs.

In line with this, the pharmaceutical industry needs to define how relevant preventative interventions fit into patient pathways too and how it can support the NHS in delivering more proactive care strategies for particular cohorts of patients.

Transforming primary care

PCNs will pave the way for ICSs to be formed in every part of the country. They will also help the NHS to fulfil other key objectives outlined in the NHS Long Term Plan, particularly with regards to providing care closer to patients’ homes.

With the new contract due to begin in July, it will be essential for the pharmaceutical industry to understand what PCNs must achieve and how they will be incentivised and measured as they begin to transform the way that primary care services are designed and delivered.

Steve How and Oli Hudson are part of Wilmington Healthcare’s Consulting Team. For information on Wilmington Healthcare. go to www.wilmingtonhealthcare.com