The state of care in urgent primary care services

This report presents findings from the Care Quality Commission’s programme of comprehensive inspections of urgent care centres, NHS 111 services and GP out-of-hours services.

state of care
Image source: http://www.cqc.org.uk

Urgent primary care services play a vital role in England’s healthcare system. They are the first step to ensure that people are seen by the professional best suited to deliver the right care and in the most appropriate setting.  A quick, safe and effective response from these services provides a good outcome for patients and takes pressure off other parts of the urgent care system.

This report presents some common themes and characteristics that the Care Quality Commission (CQC) have found from their inspections.

The report found:

  • Urgent care services are an essential part of the healthcare system, particularly in taking pressure off other parts of the NHS at times of peak demand.
  • Urgent primary care services have been able to improve. Overall, the quality is good – although one in 10 services still require some improvement, particularly in initial assessment of people and timeliness of response to urgent needs.
  • Urgent care providers face pressures with staffing and workforce planning. This is compounded by the reality of unsocial working hours and high reliance on self-employed clinicians
  • Many providers experience difficulties in accessing people’s medical records.
  • NHS 111 in particular has the potential to take pressure off the NHS – and provide a better experience for people by giving advice and treatment in one place. However, to achieve this it must be adequately resourced. Commissioners need to support providers, take action if they are not meeting their contracts and integrate services more closely.
  • Many people are not aware of the range of urgent care services available. There is a need for more public information – and consistency of service provision.

Full report: The state of care in urgent primary care services. Findings from CQC’s programme of comprehensive inspections in England

Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

The Nuffield Trust | April 2018 | Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

Health 1000 is a new model of care that aimed to improve quality of life through personalised care delivered by a clinically-led multidisciplinary team, focusing on prevention and early intervention and supported by contributions from the third sector. Individuals eligible in Barking and Dagenham, Havering and Redbridge boroughs were invited to transfer from their primary care practice to Health 1000.

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Image source: nuffieldtrust.org.uk

Using a case-control methodology, where 407 patients registered with Health 1000 were paired with a control who would be registered with another GP in the area. A combination of interviews with patients and staff and surveys were completed by staff of Health 1000 and nearly 50 primary care staff working in the boroughs.
Among the findings were:

  • Staff had reported reductions in unnecessary outpatient referrals and significant improvements to medicines management. They had also referred to the benefits of better care continuity, for example in enabling quicker discharges from hospital and avoiding duplication across the system.
  • However, there is no evidence that the service reduced use of hospital services – whether for all patients, those who satisfied the original eligibility criteria, or those at end of life. However, with the numbers of patients and the period of follow up, it may be too soon to detect any such change.

The report’s key findings and the full details of the evaluation are available from The Nuffield Trust here 

The accompanying report can be downloaded here

Workload in general practice

Ensuring patient safety through control of workload and demand management in general practice | The British Medical Association (BMA)

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General practice in England has seen consultation rates soar by nearly 14 per cent between 2007 and 2014, while the 12 months between 2016-17 saw the total number of full-time equivalent GPs fall by 3.4 per cent.

The BMA suggest that this increase in workload is because of growing patient need (complex multi-morbidity) as well as a result of the widespread recruitment and retention crisis and a lack of long-term investment in general practice. It is argued that the issue of GP workload must be addressed urgently.

This document seeks to address the current challenges in primary care.  It sets out a strategy aimed at improving safety and quality of patient care by recommending the development of agreed workload limits at a local level supported by national guidance.

Full document: Workload Control in General Practice. Ensuring Patient Safety Through Demand Management

Don’t blame GPs for high rates of antibiotic use — society must play its part, says RCGP

The Royal College of General Practitioners (RCGP) has responded to Public Health England’s research published on antibiotic prescriptions in primary care.  The PHE study found  that at  least 20% of all antibiotics prescribed in primary care in England are inappropriate. 

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Professor Helen Stokes-Lampard, Chair of the Royal College of GPs said:

“If GPs do prescribe antibiotics, it is because, in their expert opinion, they are the most appropriate treatment available, given the unique circumstances of the patients before us. However we are still coming under considerable pressure from some patients who need to understand that antibiotics are not a ‘catch all’ for every illness.”

The full response can be read at RCGP

 

In the media:

The Guardian Fifth of prescribed antibiotics are unnecessary, study finds

ITV News: One in five GP antibiotic prescriptions inappropriate 

Mapping of specialist primary health care services in England for people who are homeless not linked to specialist primary health care service

Homelessness is a growing problem in many areas across England, and can have a devastating impact on health and well-being. People who are homeless and sleeping rough or staying in hostels and shelters have significantly higher levels of physical and mental health problems, and problematic drug and alcohol use, than the general population. There are many difficulties in addressing their health care needs. (King’s College)

A new study funded by National Institute for Health Research (NIHR) collected data from 243 homeless projects not linked to a specialist primary health care service, asking about their views and experiences of primary health care arrangements for their clients. The report is the result of a systematic mapping exercise across England of specialist primary health care services for single people who are homeless (hereafter specialist primary health care services). The mapping exercise originates from a larger study (still in progress) which is is examining the integration, effectiveness and cost-effectiveness of different models of delivering primary health care to people who are homeless (HEARTH study).

mapping
Image source: http://www.kcl.ac.uk

Key findings:

  • One in 10 managers of such projects (11%) said that their clients experienced ‘a lot’ of difficulties accessing primary health care services;
  • Nearly half (47%) said that their clients experienced ‘some’ difficulties;
  • Fewer (43%) said that there were no problems;
  • Difficulties were most commonly reported by managers of projects in parts of NHS Midlands and East Region, and the South West and South East Regions.

The lead researcher, Dr Maureen Crane said:

‘At present there are evidence gaps to guide health service commissioners and providers about the most appropriate types of primary health care services for people who are homeless. Better understanding of the effectiveness of different models in different settings is crucial if their primary health care needs are to be successfully addressed.’

Further details of the study are available from King’s College 

King’s College Social Care Workforce Research Unit have published three study mapping documents, they are all available to download from the King’s College Policy Institute website 

Alternatively each document can be accessed following the links below:

Report:  Mapping of specialist primary health care services in England for people who are homeless.

Summary report: Mapping of specialist primary health care services in England for people who are homeless. Summary of findings and considerations for health service commissioners and providers.

 

Inventory: Inventory of specialist primary health care services in England for people who are homeless  

 

 

 

Primary care home: exploring the potential for dental care to add value

The National Association of Primary Care has published a report considering how  dental care could fit within the Primary Care Home Model.  

Dental
Image Source: National Association of Primary Care

This paper explores how collaboration between medical and dental care can be improved. Despite both working in a primary care setting, collaboration between the two is limited.

It provides an overview of the dental
sector and the issues facing both professions to highlight how this could happen. It also looks at
some of the potential mutual benefits through improving working practices. This is intended as an
initial review, with more work to follow on dental pilots within primary care homes.

Further information from the National Association of Primary Care