Kings Fund 19 February 2014
- This report describes examples of innovative models of primary care provision through four case studies in different areas of England. It also highlights how the existing system is imperfectly understood, particularly regarding existing contractual models.
- Key findings
- Demographic changes, increasing multi-morbidity, clusters of risk factors and the rising needs of frail older people are piling pressure on primary care.
- General practice is well placed to respond to these pressures, due to its registered list of patients. This permits practices both to tailor treatment and act preventively.
- When developing integrated community services, there must be engagement with social services to help people stay independent and out of hospital. Making high standard out-of-hospital services available 24/7 is essential to halting the rising use of hospitals.
- Currently practices cannot fully meet their ambitions to develop innovative care due to challenges posed by structural instability, shifting accountabilities, provider engagement and payment models.
- The case studies demonstrate considerable innovation within the current system, but also great complexity and instability. Organisational change and loss of organisational memory compound this. Technicalities of contracting are imperfectly understood, inhibiting the flexibility that already exists.
