Does home-based primary care improve patient outcomes?

An Overview Of Home-Based Primary Care: Learning From The Field | Commonwealth Fund

This Commonwealth Fund briefing synthesises the evidence and expert perspectives on how outcomes and costs are affected by utilising home-based primary care for housebound or functionally-limited patients. It finds that successful home-based primary care uses multidisciplinary teams, behavioural insights, social support and rapid response to acute care needs to reduce care costs and improve patient outcomes.

The briefing concludes that successful home-based care practices have achieved robust savings, but the future of the model will rely on innovative payment models and training initiatives.

Why do patients seek primary medical care in emergency departments?

MacKichan, F. (2017) BMJ Open. 7:e013816

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Objectives: To describe how processes of primary care access influence decisions to seek help at the emergency department (ED).

Conclusions: This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around ‘inappropriate’ patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups.

Read the full article here

UK top in primary care co-ordination according to international survey

The UK emerges as the first of 11 countries in an international survey of care co-ordination in primary care settings | The Commonwealth Fund

In a survey of health care experiences in 11 high-income countries, the rate of poor primary care coordination was 5.2 percent overall and 9.8 percent in the United States, the highest rate. Patients who have a positive, established relationship with their provider were less likely to report poor primary care coordination. Being young or having a chronic illness was associated with poor care coordination.

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Image source: The Commonwealth Fund

The dimensions of care coordination assessed for this study were:

  • access to medical records or test results;
  • receiving conflicting information;
  • use of diagnostic tests that the patient felt were unnecessary; sharing of information between primary care doctor and specialist.

The UK had the highest percentage of patients reporting no care coordination gaps within primary care.

Full results can be accessed here

 

 

Early benefits of delegated commissioning

NHS England have produced a series of Delegated commissioning case studies to show how CCGs are using delegated commissioning to improve care for local people. 

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CCGs have reported that delegated commissioning is leading to:

  • The development of clearer, more joined up visions for primary care, aligned to wider CCG and STP plans for improving health services;
  • Improved access to primary care;
  • Improved quality of care being delivered to patients;
  • Improved CCG relationships with member practices, including greater local ownership of the development of primary care services;
  • Increased clinical leadership in primary care commissioning, enabling more local decision making;
  • Greater involvement of patients in shaping services;
  • A more sustainable primary care system for the future.

 

NHS England have produced a series of case studies to show how CCGs are using delegated commissioning to improve care for local people:

Dentists’ morale has generally fallen

This report explores the relationship between the motivation and morale of selfemployed primary care dentists and their working patterns.

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Despite this, over half of dentists (57 per cent) report that they have the opportunity to do challenging and interesting work and 55 per cent agreed that they feel good about their job. However, the report also found that the more time dentists spent on NHS work, the lower their levels of motivation.

The report explores the relationship between dentists’ motivation and morale and their working patterns, considering in particular:

  •  Weekly hours of work
  •  Division of time between NHS and private dentistry
  •  Division of time between clinical and non-clinical work
  •  Weeks of annual leave
  •  Age

Read the full overview here

Read the full report here

The digital patient: transforming primary care?

 

This report from The Nuffield Trust reviews the evidence that exists on digital technology and its impact on patients in primary care and the NHS. It explores the impact of seven types of digital services offered by the NHS:

  1. Wearables and monitoring technology
  2. Online triage tools
  3. Online sources of health information and advice, targeted interventions and peer support
  4. Online appointment booking and other transactional services
  5. Remote consultations
  6. Online access to records and care plans
  7. Apps

The report finds that patient-facing technology is already showing promise that it can improve care for patients and reduce strain on the stretched health service – particularly for people with long-term conditions such as diabetes or COPD. However, this rapidly evolving market comes with risks. Many apps, tools and devices have not been officially evaluated, meaning that their effectiveness is unknown. In some cases, technology can increase demand for services, disengage staff and have the potential to disrupt the way that patients access care.

Moreover, the report warns that policy-makers and politicians should avoid assuming that self-care-enabling technology will produce significant savings, at least in the short term.

The report also presents a series of lessons and recommendations to NHS professionals, leaders and policy-makers about how best to harness the potential of technology and avoid the pitfalls.

See also: Why the NHS must tackle digital exclusion | Nuffield Trust

Freedom to speak up in primary care

Freedom to speak up in primary care: guidance to primary care providers on supporting whistleblowing in the NHS | NHS England

kick-off-879382_1280This guidance aims to make it easier for all staff providing NHS primary care services to raise their concerns so that action can be taken and improvements made.

It details the principles and actions to apply in primary care when raising concerns about the delivery of primary care services to patients.

The guidance comes after Sir Robert Francis recommended that the principles outlined in his Freedom to Speak Up report be adapted for primary care, where smaller work settings can present challenges around anonymity and conflicts with employers.