Although the foundations of system working have been established through legislation and national guidance, progress against the core aims of integration and better health is often most visible closer to where healthcare is delivered.
Primary care providers across the country are expanding beyond the provision of core GP services to find new ways to improve the health of their populations. Much of general practice has traditionally been delivered by primary care teams working from individual surgeries, but working at scale creates new opportunities for improving patient care. This can be through improving workforce resilience, driving efficiency, or sharing resources.
While recent policy direction has encouraged the development of primary care networks (PCNs) as a key way of bringing GP services together across multiple sites, practices are also adopting a range of other models of at scale working including super-practices, GP federations and direct integration with NHS trusts. Through 'at scale' primary care we can see how successful integration and collaboration has been happening on the ground, bringing the vision of the Fuller Stocktake to life.
NHS Providers has worked with leaders from several well-known, large primary care providers through the At Scale Primary Care Networking Group to explore how organisations are addressing systemic challenges. They've demonstrated real innovation and commitment to improve patient care and meet shared system and national ambitions.
Personalised care is a key part of the NHS Long Term Plan and was advocated in the Fuller Stocktake. As well as improving patient outcomes, community-centred approaches can alleviate pressures on other parts of the system, such as NHS trusts, to offer preventative support and ensure patients can access care in the most appropriate setting, including at home and in the community.
Lakeside Healthcare, a GP partnership serving patients across eight practices and working in 13 local sites, has introduced personalised care teams across several of its PCNs. These include social prescribers who work with patients outside of the GP surgery setting in their communities, where they feel most comfortable, and empower them to take control of their own health and wellbeing. Lakeside's personalised care teams take an integrated approach, such as supporting patients with early cancer diagnosis alongside colleagues from the secondary and voluntary sectors. When patients are diagnosed at their local trust, Lakeside accesses shared clinical information and offers personalised care to help them cope with those early days of diagnosis.
Another multi-site GP partnership, the Hurley Group, is working with third sector organisations to identify and support people addicted to gambling. As promoted by the Fuller Stocktake, the group is establishing multidisciplinary teams at a neighbourhood level to support the health and wellbeing of communities. Fuller's focus on workforce as a key enabler of change is also demonstrated as GPs are building their knowledge of gambling addiction through new training being developed with the Royal College of General Practitioners. These interventions have led to a demonstrable reduction in waiting times for care and an increase in problem gambling referrals, helping patients to access the support they need.
Fuller's vision of multidisciplinary teams and emphasis on the value of data are also demonstrated by at scale provider Symphony Healthcare Services, a wholly owned subsidiary of Somerset NHS Foundation Trust. Using data available through its clinical system and bringing together professionals including prescription clerks and medication optimisation assistants, it has successfully improved processes around high-risk medication monitoring.
A scorecard monitoring performance across multiple indicators is reviewed monthly to ensure patients are taking the right medication at the right time, and that any risks are managed. Through treating and managing conditions such as diabetes in primary care and sharing best practice across sites, the likelihood of additional treatment in acute settings is reduced, and the whole system benefits.
These are just three case studies in our new report exploring how working at scale has enabled leading primary care providers to help systems tackle inequalities, meet demand and build resilience. We have seen real results, such as improved long-term condition management for those with hypertension. And these outcomes have benefitted their wider systems by helping deal with issues before they escalate.
At scale working in primary care helps to resolve some of the issues currently facing the NHS, including workforce resilience and continuity of care. It contributes to national and shared system aims, and it has been shown to improve outcomes for patients. At a time when system working is challenged by pressures elsewhere, primary care at scale has demonstrated a way to make the integration agenda happen – from the ground up.
This blog was first published by HSJ.