Improving primary and community care

Realising the neighbourhood NHS: delivering a new deal for primary care in England | The Institute of Public Policy Research

This paper provides new evidence and ideas to improve the provision of primary and community care.  It argues there should be a ‘new deal’ for general practice which should consist of:

  • creating neighbourhood care providers to deliver the ‘neighbourhood NHS’
  • offering all GPs the right to NHS employment
  • reforming new GP roles to create career progression, time to care and realistic workload
  • a radical transformation of the primary care infrastructure.

£1.5 billion to deliver Government commitment for 50 million more general practice appointments

Government and NHS commit an additional £1.5 billion in total for general practice | Department of Health and Social Carestethoscope-1584223_1920

The Government and NHS England have committed at least an additional £1.5 billion for general practice over the next four years for additional staff, a key step towards delivering 50 million more appointments in general practice by 2024.

In addition to the Government’s commitment to invest in general practice under the Long Term Plan, this funding is for the recruitment of 6,000 more primary care professionals as well as for initiatives to support the recruitment and retention of doctors in general practice.

In agreement with the profession, the General Practice Contract for 2020/21 will also offer more check-ups for new mums as part of a major deal with England’s family doctors.

Also included in the agreement are regular visits for care home residents, assessing medication and new incentives to increase uptake of vaccinations and learning disability health checks, expand social prescribing referrals, and improve prescription safety checks.

Expanding the new workforce will allow GPs to focus on the sickest patients and will in time allow them to provide longer appointments to people who need one.

Full story at Department of Health and Social Care

Yorkshire patients needed for irritable bowel syndrome trial

University of Leeds | January 2020| Yorkshire patients needed for irritable bowel syndrome trial

Researchers from the University of Leeds are recruiting participants to join a trial of  low-does Amitriptyline (a tricyclic antidepressant) for irritable bowel syndrome (IBS). 

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IBS is a common gut disorder affecting one in ten people. Abdominal pain, bloating, and altered bowel habit affect patients’ quality of life substantially, and can force them to take days off work.

Low-dose amitriptyline is recommended as a treatment option for people who have persistent, troublesome IBS symptoms. It is thought to work at low doses in IBS because it has pain-relieving properties and changes bowel activity. However, there have been no large studies done in primary care to test whether or not it works (Source: University of Leeds).

Full details from University of Leeds

BBC News IBS trial to test amitriptyline as potential common treatment

 

 

New framework launched provides core capabilities clarity for advanced level nurses in primary care/general practice, promoting a high standard of patient care

Skills for Health | January 2019 | New framework launched provides core capabilities clarity for advanced level nurses in primary care/general practice, promoting a high standard of patient care

A framework launched this week provides clarity around the core capabilities required by advanced level nurses working in primary care/general practice and will promote a high standard of care for those utilising the services. It will allow nurses to showcase their advanced level knowledge, skills and behaviours which will be essential in the development of the multi-professional teams to provide excellent prevention and care for people accessing their services.

This framework sets a standard regarding the academic knowledge, skills and behaviours required to enable the highest standards of practice within primary care and general practice. It will support nurses working at an advanced level to demonstrate and evidence their capabilities to service commissioners, employers, people utilising health care and the public. (Source: Skills for Health).

 

skillsforhealth.org.uk
Image source: skillsforhealth.org.uk

Royal College of General Practitioners  & Skills for Health

The Core Capabilities Framework for Advanced Clinical Practice (Nurses) Working in General Practice/Primary Care in England 

Further information is available from Skills for Health 

 

Primary Care Networks: an overview for general practice teams

Primary Care Commissioning | August 2019| Primary Care Networks an overview for general practice teams

Primary Care Commissioning has released a slide deck to provide an overview for general practice teams, it covers the following:  

  1. Practice contracts
  2.  Background to changes
  3.  Your PCN
  4. Changes to QOF
  5. IT
  6. Network services
  7. Workforce
  8.  Funding
  9. Full details from Primary Care Commissioning

It also signposts key documents for PCNs

Its available from the PCC

 

Homeless unable to access primary care

Gunner, E.,  et al.  | 2019| Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

Research that sought the views of 22 homeless people and explored their experiences and access to primary care services, report that homeless people perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. 

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Abstract

Background Anecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population’s views and experiences of such services.

Aim To explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services.

Design and setting A qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England.

Method Semi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis.

Results A total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described. Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need. A participant described committing crimes with the intention of going to prison to access health care. High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH).

Conclusion Participants perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. Changes are imperative to facilitate access to primary health care, improve patient experiences of mainstream services, and to share best practices identified by participants at the SPHCPH.

 

Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

In the news:

OnMedica Homeless people report being unable to register with primary care

The Library & Knowledge Service can provide access to this article for Rotherham NHS Staff, request a copy here 

Insights from the spread of the primary care home

The King’s Fund | June 2019 | Insights from the spread of the primary care home

The King’s Fund has published Insights from the spread of the primary care home, a report that looks at the factors that contributed to the spread of the ‘primary care home’,  a type of primary care network, from concept to more than 200 sites in a few years. The King’s Fund draw on a series of interviews with staff from the National Association of Primary Care (NAPC, who curated the primary care home concept for use in England in 2015), NHS England (who supported the work) and local sites (who delivered changes on the ground).

.kingsfund.org.uk
Image source: .kingsfund.org.uk

 

The report identifies factors that enabled the spread of primary care homes, as well as the factors that made the spread harder. It provides insights for the NAPC and others that can inform their health and care transformation efforts (Source: The King’s Fund).

Report available from The King’s Fund 

New roles in primary care networks

NHS England | June 2019 | New roles in primary care networks

NHS England has published a series of documents to support pharmacists in the primary care networks. 

New roles in primary care networks: the clinical pharmacist

Primary care networks: A briefing for pharmacy teams

Guidance for Local Pharmaceutical Committees (LPCs) – How to help contractors get involved with Primary Care Networks

Improving access out of hours: Evaluation of extended-hours primary care access hubs

Nuffield Trust | May 2019 | Improving access out of hours: Evaluation of extended-hours primary care access hubs

The Nuffield Trust was commissioned by Barking, Havering and Redbridge CCGs to evaluate the impact of access programmes in these boroughs.

The schemes aimed to improve the quality of primary care services and to improve patients’ experience and outcomes over a two-year period.

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The schemes involved:

  • improving public access to primary care by providing additional capacity outside of core hours
  • the development of a new integrated care hub for the management of people with complex care needs.

Key findings:

  • Most of the patients we interviewed told us that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
  • Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
  • Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during our research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
  • However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
  • During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
  • The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
  • Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
  • Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
  • It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.

Full details from the Nuffield Trust

Primary care networks and the deprivation challenge

The newly emerging primary care networks provide an opportunity to tackle health inequalities in England but, as Rebecca Fisher and Beccy Baird explain, they will have to be careful to avoid perpetuating the problem | via BMJ

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In the face of a growing health gap between rich and poor in England, the NHS long-term plan explicitly commits to a focus on “health inequality reduction.” The roots of socioeconomic inequalities lie deep within communities, and general practice—itself rooted in communities—is key to addressing the problem. As practices scrabble to organise themselves into primary care networks, making meaningful progress towards reducing health inequalities requires these networks to be part of the solution. But unless a combination of quirks, oversights, and loopholes in their design and contracting are addressed, there is a risk that they could perpetuate the problem.

Full article: Primary care networks and the deprivation challenge: Are we about to widen the gap? | Rebecca Fisher [The Health Foundation] | Beccy Baird [The King’s Fund] | BMJ