Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme

International Journal of Integrated Care, May 2018

This article addresses the challenge of how to implement integration within primary care services. It shares learning from a UK based improvement programme which reflected international interest in transferring activities from hospital and community and developing holistic primary care that responds to the needs of the local community. Programme components included additional per capita funding for involved practices, monthly learning sets between pilot leads, and a formative evaluation. Practices had flexibility in how to use the additional funding to meet local needs and were selected through a competitive process. The programme successfully delivered diagnostic and treatment activities previously provided in acute hospital. Some practices also introduces new holistic approaches which were mostly sustained at the end of the twelve month period. The programme demonstrates that transformation of primary care requires a change in the internal paradigms held by clinicians and purchasers, careful design of learning opportunities, responding to multiple levels of motivation, and deployment of relevant change infrastructures and improvement methodologies.

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Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme

Integrated Care Cases Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme Author: Robin Miller Health Services Management Centre, University of Birmingham, GB Profiles: About Robin Robin is a Senior Fellow and Director of Evaluation at the Health Services Management Centre at the University of Birmingham. He leads applied research projects within health and care, with a particular focus on evaluating and learning from change initiatives. X close Abstract This article addresses the challenge of how to implement integration within primary care services. It shares learning from a UK based improvement programme which reflected international interest in transferring activities from hospital and community and developing holistic primary care that responds to the needs of the local community. Programme components included additional per capita funding for involved practices, monthly learning sets between pilot leads, and a formative evaluation. Practices had flexibility in how to use the additional funding to meet local needs and were selected through a competitive process. The programme successfully delivered diagnostic and treatment activities previously provided in acute hospital. Some practices also introduces new holistic approaches which were mostly sustained at the end of the twelve month period. The programme demonstrates that transformation of primary care requires a change in the internal paradigms held by clinicians and purchasers, careful design of learning opportunities, responding to multiple levels of motivation, and deployment of relevant change infrastructures and improvement methodologies. Keywords: general practice ,   primary care ,   transformation ,   commissioning ,   integration   How to Cite: Miller R. Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme. International Journal of Integrated Care. 2018;18(2):13. DOI: http://doi.org/10.5334/ijic.3044 286 Views 122 Downloads 17 Twitter   Published on 18 May 2018 Peer Reviewed  CC BY 4.0 Introduction and national context Primary care is a key component of a more integrated and person-centred health and care system [1, 2, 3]. English primary care is based around general practice and reflects characteristics reflecting strong primary care – is it largely free at the point of access, supports individuals from ‘cradle to grave’, acts as a co-ordinating point of the wider public health system, and has a capitated budget to support an identified patient population [4, 5, 6]. Despite these strengths, English general practice and therefore the primary care system in which it is situated, does not consistently demonstrated integrated and person-centred care [7, 8, 9, 10]. This is partly due to structural factors such as conflicting organisational objectives, sectorial policy priorities, and activity based incentive systems. Practice issues related to professional differences, insufficient collaborative skills and lack of system knowledge also contribute [9, 10]. National policy priorities for improvement have therefore included co-ordinating care for those with complex needs, encouraging healthy lifestyles, and pro-actively detecting and responding to key long-term conditions [11]. English general practitioners (GPs) have traditionally owned the general practices in which they work and employed reception, practice management and nursing staff members. GPs have a hybrid status that is unusual in the UK NHS as it combines private profit with public sector benefits [12]. This means that GPs are generally not directly managed by government and instead policy makers have to deploy other levers. Responsibility for overseeing general practice has been split between national government and local healthcare purchasers (or commissioners in English terminology). Levers to influence the practice of GPs include national contracts setting out expected activities, local incentive payments to encourage adoption of identified health promotion practices, increased diversification of providers to enhance support for under-doctored localities and populations, and independent inspections of general practice by the quality regulator [13, 14]. Since 2004 the national Quality and Outcomes Framework has been central to the policy maker – general practice relationship. Initially this pay for performance scheme led to improvement health outcomes and decreased hospital attendance for targeted conditions, but these have largely returned to the previous rate of improvement [15, 16]. Doctors and nurses report decrease in person-centred practice since QOF was introduced and that patients are less satisfied with continuity of care [17]. National policy has sought to engage GPs in leading more fundamental reform of the public healthcare system. This includes the transfe (...truncated)


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Robin Miller. Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme, International Journal of Integrated Care, 2018, pp. 13, Volume 18, Issue 2, DOI: 10.5334/ijic.3044