31 de març 2019

New organisational models of primary care to meet the future needs of the NHS

The NHS in England (the same occurs in Spain) faces several future challenges for primary care, including an ageing population, increasing numbers of patients with multiple long-term conditions and a limited workforce. The Health Education England Primary Care Workforce Commission  set out to identify innovative models of primary care that will meet these future challenges.

RAND Europe was commissioned in 2015 to present a brief overview of reports from professional bodies and policy-focused organisations — from England and internationally — that describe new models for delivering primary care. These models include:
  • Models that introduce new roles, or change existing roles, in general practice (e.g. introducing physician associates and pharmacists into general practice, extending roles for allied health professionals and primary care nurses);
  • Models of collaboration among professionals and among the primary care, secondary care and social care sectors (e.g. 'micro-teams', GPs and specialists working together and/or specialists working in the community, extended roles for community pharmacists); and
  • New organisational forms for general practice (e.g. primary care federations or networks, super-practices, regional multipractice organisations, community health organisations, polyclinics and multispecialty community providers).
The review concluded that there is no ‘one size fits all’ model for delivering primary care and that the way in which changes are implemented may be as important as the model of change itself. Although several cross-cutting principles of good practice were identified. These are design principles from delivering primary care adapted from Smith et al. (2013)
    • Entry to the system: patients should be able to speak to a senior health professional as early as possible and both within and out of hours.
    • Specialists and generalists: there is a range of ways in which specialists and generalists could work more effectively together. Patients should have the minimum number of separate visits and consultations that are necessary, with access to specialist advice in appropriate locations
    • Continuity and access: patients should be offered continuity of relationship where this is important, and access at the right time when it is required.
    • Anticipatory and multidisciplinary care: care should be proactive and population-based where possible, especially in relation to long-term conditions.
    • Multimorbidity: care for frail people with multimorbidity should be tailored to the individual needs of patients, in particular for people in residential care or nursing homes.
    • Patient self-management: where possible, patients should be supported to identify their own goals and manage their own condition(s) and care, drawing on health professional support as needed.
    • Making the most of the multidisciplinary team: primary care should be delivered by a multidisciplinary team in which full use is made of all the team members’ skills.
    • Patient records: there should be a single electronic patient record that is accessible by relevant organisations and that can be read and, perhaps in future be added to, by the patient.
    • Quality and information: primary care organisations should use, and make publicly available in real time, information about the quality and outcomes of care.
    • Organisation and management: Primary care should have professional and expert management, leadership and organisational support.
    photo: Josep Guinovart (2003) El cor de l'era (on es pot aprendre com destriar el blat de la palla)