Diagnosing cancer in primary care

The British Journal of General Practice has published Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit. This audit shows that GPs are doing a good job at identifying patients they suspect of having cancer, and referring them in an appropriate and timely manner within five days of initial presentation. The findings highlight the usefulness of audits in taking a stocktake of where primary cancer is in cancer diagnosis across the NHS, and identifying areas for improvement moving forward.

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Commissioning primary care services

NHS England has updated the Primary medical care policy and guidance manual to reflect the changing landscape in primary care co-commissioning.   This document provides commissioners of primary care services the context, information and tools to safely commission and contract manage primary medical care contracts.

The document is split into four sections:

Part A – Excellent Commissioning and Partnership Working

Part B – General Contract Management

Part C – When things go wrong

Part D – General

‘Data revolution’ crucial to transformation

A ‘data revolution’ across health and care services in England is vital if local areas are to transform the way care is delivered | NHS Confederation

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The NHS Confederation has launched a new series of guides to help board members to better understand data across the healthcare system and its role in transforming care.

Produced in association with healthcare intelligence provider CHKS, the guides for non-executive directors (NEDs) aim to kick start a ‘data revolution’ by looking at how data can be used to drive improvement, provide effective oversight and support the transformation of care. The first guide is aimed at NEDs in acute care, and examines activity in both primary and secondary care settings and considers the role of data sharing in bringing about efficiency savings.

Full document: The non-executive director’s guide to NHS data. Part one: Hospital activity, data sets and performance

 

Commissioning mental health services in primary care

Of primary importance: commissioning mental health services in primary care  | NHS Clinical Commissioners

This report highlights projects where CCGs and their partners are delivering better care for patients, working across the boundaries between physical and mental health, as well as health and social care, while at the same time reducing pressure on GPs and hospitals.

Developed by NHS Clinical Commissioner’s Mental Health Commissioners Network, the report aims to share learning and good practice from these projects to help support others looking to implement projects across primary care.

Case studies in the report include:

  • Community Living Well in West London which helps those with long-term mental health conditions and covers a full range of psychological therapies from guided self-help, through to sessions of short-term psychodynamic or CBT, carers therapy and a wellbeing service.
  • Work in Sheffield where IAPT workers are attached to each of the CCG’s individual 85 practices, and are incorporated as part of the practice multidisciplinary team.
  • The Well Centre, a primary care health centre in Lambeth for young people aged 13 to 20 offering support with all areas of health including mental wellbeing.

Full report available here

Point of care testing in primary care

Research concerning point of care testing (POCT) in primary care finds that the total expected cost of using POCT to deliver an NHS Health Check in primary care is lower than the laboratory-led pathway.  It also minimises DNA rates and only requires one visit from the patient.

Abstract:
Objective: To determine if use of point of care testing (POCT) is less costly than laboratory testing to the National Health Service (NHS) in delivering the NHS Health Check (NHSHC) programme in the primary care setting.

Design: Observational study and theoretical mathematical model with microcosting approach.

Setting: We collected data on NHSHC delivered at nine general practices (seven using POCT; two not using POCT).

Participants: We recruited nine general practices offering NHSHC and a pathology services laboratory in the same area.

Methods: We conducted mathematical modelling with permutations in the following fields: provider type (healthcare assistant or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), cost of consumables and variable uptake rates, including rate of non-response to invite letter and rate of missed [did not attend (DNA)] appointments. We calculated total expected cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters.

Main outcome measures: We collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a pathology services laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices.

Results: TEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of cardiovascular disease risk score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment.

Conclusions: TEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pathway. Using POCT minimises DNA rates associated with laboratory testing and enables completion of NHSHC in one sitting.

Full reference: Does use of point-of-care testing improving cost-effectiveness of the NHS Health Check programme in the primary care setting?  A cost-minimisation analysis

 

New model of Primary Care provision

New report from the Nuffield Trust evaluates an initiative called the Primary Care Home (PCH) model developed by the National Association of Primary Care (NAPC).

The primary care home model was developed by the National Association of Primary Care as a response to workforce challenges, rising demand and opportunities to shape transformation in local health and care systems across England.

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Image source: nuffieldtrust.org.uk

This report from the Nufield Trust suggests that the new models of primary care provision are showing early signs of success but will need more resources and support for these models to work well on a permanent basis.

The evaluation found that participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals while also stimulating new services and ways of working, tailored to the needs of different patient groups.

It was judged to be too early in the scheme’s development for the Nuffield Trust to quantify impacts on patient outcomes, patient experience or use of wider health services.

Full report: Primary Care Home. Evaluating a new model of primary care.

Related: New primary care model needs resources, say experts | OnMedica

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.

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Image source: http://www.commonwealthfund.org