Benefits of GP care in outreach settings for people experiencing homelessness: a qualitative study

Benefits of GP care in outreach settings for people experiencing homelessness: a qualitative study
British Journal of General Practice 2021; 71 (709): e596-e603. DOI:https://doi.org/10.3399/BJGP.2020.0749

• An exploration of experiences of people experiencing homelessness of GP care in three community outreach settings in UK.

Abstract

Digital Innovation for Future-proofing Primary Care

Digital Innovation for Future-proofing Primary Care
Push Doctor July 2021

• This report explores how primary care networks (PCNs) might use digital solutions to create a more sustainable future. 
• Free registration is required to download this report.

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme.

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme.
Health Econ. 2021 Jun;30(6):1393-1416. doi: 10.1002/hec.4262. Epub 2021 Mar 30. PMID: 33786914.

• A survey of local commissioners about their use of financial incentives linked to numbers of programme referrals and attendances from 5170 general practices in England between April 2016 and March 2018 found that financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Outcome incentives were the only form of pay-for-performance to stimulate more participation in this national disease prevention programme.

Exploring Feedom to Speak Up in Primary Care nad Integrated Settings

Exploring Freedom to Speak Up in Primary Care and Integrated Settings
National Guardian June 2021

• This report presents an overview and key findings of the work carried out by the National Guardian’s Office (NGO) in partnership with colleagues in primary care and integrated settings to support the growth of Freedom to Speak Up and the introduction of the Freedom to Speak Up Guardian role.
• It identifies two models to support primary care organisations in developing their speaking up arrangements:
• Freedom to Speak Up within an organisation – such as a GP practice or Dental surgery; or a CCG
• Freedom to Speak Up within a network or defined structure – for example a partnership; a local support; or an Integrated Care System Model.

The role of primary care in integrated care systems

The role of primary care in integrated care systems
NHS Confederation 27 May 2021

• This report sets out the views of primary care members on the underpinning principles needed for strong primary care involvement at system and place.

Health Creation: How can Primary Care Networks succeed in reducing health inequalities?

How can Primary Care Networks succeed in reducing health inequalities?
Health Creation Alliance, RCGP February 2021

• Report from a series of multi-stakeholder events held between February and September 2020 which explored the following questions:
• How can general practice and primary care work differently with communities and local partners to reduce health inequalities?
• What can PCNs do to enable and create the conditions for practices to work differently with local partners to reduce health inequalities?

Sociodemographic inequalities in patients' experiences of primary care between 2011 and 2017.

Sociodemographic inequalities in patients' experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017.
J Health Serv Res Policy. 2021 Jan 31:1355819620986814. doi: 10.1177/1355819620986814.

• Using data from the General Practice Patient Survey in England this study sought to trace variations in primary care experience over recent year. It considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience of primary care. It concludes that there have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.

Vertical integration - acute Trusts providing GP services

Vertical integration - acute Trusts providing GP services
Southampton: NIHR Health Services and Delivery Research Topic Report; 2020. DOI: https://doi.org/10.3310/hsdr-tr-131295

• Vertical integration refers to merging organisations that operate at different stages along the patient pathway. An organisation running an acute hospital and also operating primary care medical practices is an example of vertical integration. 
• Researchers investigated: what specifically has led to hospitals and GP practices being run by the same organisation; how it is done; the expectations of the GPs and NHS managers who made it happen; whether those expectations are being fulfilled; and whether there are any other consequences.

Hospital admissions after vertical integration of general practices with an acute hospital

Hospital admissions after vertical integration of general practices with an acute hospital: a retrospective synthetic matched controlled database study
British Journal of General Practice 2020; 70 (699): e705-e713. DOI: https://doi.org/10.3399/bjgp20X712613

• A retrospective database study using synthetic controls of an NHS hospital in Wolverhampton integrated with 10 general practices, providing primary medical services for 67 402 registered patients. 
•  Across the 10 practices, pooled rates of ED attendances did not change significantly after vertical integration. However, there were statistically significant reductions in the rates of unplanned hospital admissions and unplanned hospital readmissions per 100 patients per month. These effect sizes represent 888 avoided unplanned hospital admissions and 168 readmissions for a population of 67 402 patients per annum. Utilising NHS reference costs, the estimated savings from the reductions in unplanned care are ∼£1.7 million.

Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use.

Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use.
Br J Gen Pract. 2020 Oct 1;70(699):e740-e748. doi: 10.3399/bjgp20X712793. PMID: 32958534; PMCID: PMC7510844.

• To describe availability and use of Early Admission Risk Stratification (EARS) tools across the UK, and identify factors perceived to influence implementation. An online survey identified 39 different EARS tools in use. Nearly 40% of areas using EARS tools reported introducing or realigning services as a result, but relatively few reported use for service evaluation.

Whole Systems Integrated Care toolkit

Whole Systems Integrated Care toolkit
RCGP
A toolkit developed by NorthWest London Collaboration of CCGs (launched 2014) to support commissioners, providers and communities across health and social care to work towards the vision of integrated care.

Evaluation reports include

Evaluating the design and implementation of the whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link.
BMC Health Serv Res. 2019 Apr 15;19(1):228.
Findings indicate that commissioning has significant limitations in enabling large-scale change in health services, particularly in engaging providers, supporting implementation, and attending to both its transactional and relational dimensions.

North West London Whole Systems Integrated Care: a case study.  [conference abstract]
International Journal of Integrated Care. 2016;16(6):A246. DOI: http://doi.org/10.5334/ijic.2794

Putting integrated care into practice: the North West London experience

Nuffield Trust and LSE, October 2015
Evaluation report of the early stages (February 2014 - April 2015) of the Whole Systems Integrated Care (WSIC) programme in North West London.

Collecting rapid COVID-19 intelligence to improve primary care response

Collecting rapid COVID-19 intelligence to improve primary care response
NIHR ARC West

• The aim of this project is to identify the changing demands on GP practices across Bristol, North Somerset and South Gloucestershire during the COVID-19 pandemic and investigate common challenges and innovative solutions that practices have devised to cope with this.
• Researchers are publishing a series of regular reports summarising findings. Early reports:
• Project Summary Report 1-5 June 2020 (PDF) This first summary report presents qualitative findings from 22 interviews held with GPs and managers from 14 GP practices between 13 and 17 May 2020. There is a sub-section on new consultation models implemented in this report
• Project Summary Report 2-19 June 2020 (PDF) This second summary report presents qualitative findings from 23 interviews held with GPs and managers from 20 GP practices between 28 May and 13 June 2020. There is a sub-section on perceived impact on health inequalities in this report.

Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK

Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK
British Journal of General Practice 13 July 2020; bjgp20X710933. https://doi.org/10.3399/bjgp20X710933

• Data on consultations [n=3 851 304] between 17 February and 10 May 2020 for patients aged ≥65 years drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK.
• Overall, the rate of consultations dropped by 27.1%. Face-to-face consultations fell by 64.6% and home visits by 62.6%. Telephone and electronic/video consultations made up 18.4% (17.9% teleconsultations, 0.5% electronic/video consults) of appointments in week 8, compared with 56.6% (55.1% teleconsultations, 1.5% electronic/video consultations) of appointments by week 14.
• "There was a high degree of inter-practice variation in terms of adoption of remote consultation means, and considerable unexplained variation within the current model. Categorisation of consultation type relies on how this has been recorded within the original dataset. This may lead to inaccuracies, for example, where a clinician changes between type but does not record the switch."

Abstract

Primary Care Support England (PCSE)

Primary Care Support England (PCSE)
On 1 September 2015, Capita plc took on responsibility for delivering NHS England’s primary care support service

• In July 2020 PCSE launched a new public-facing Performer List website.

Realising digital-first primary care: Shaping the future of UK healthcare

Realising digital-first primary care: Shaping the future of UK healthcare
Deloitte Centre for Health Solutions February 2020

• This report focuses on digitalisation of primary care and discuss the current state, challenges and potential of digital transformation in general practice. It highlights the key steps needed to improve the adoption of technology by patients, practitioners and the wider healthcare system. The over-riding message is clear: if primary care is to survive and thrive, it has to make the most of technology.

Primary Care Networks Draft Service Specifications

Network Contract Direct Enhanced Service: Draft Outline Service Specifications
NHS England 23 December 2019

• A draft of the five national service specifications which will be delivered by Primary Care Networks - in collaboration with community services and other providers - from April 2020. Feedback received through a survey (closing 15 January 2020) will inform processes to finalise national contracts.

CliniTECS website

CliniTECS website http://www.clinitecs.uk/

• The CliniTECs website has been designed to support health professionals undertaking up-skilling courses in the use of Technology Enabled Care Services (TECS). It includes a handbook “Making Digital Healthcare Happen in Practice”, TECs for a range of health conditions, and explanations of different technologies eg Facebook, animations and apps.

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis.

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis.
Health Serv Deliv Res 2019;7(41) December 2019

• Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified.

The social cure of social prescribing

The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision
BMJ Open 2019;9:e033137. 14 November 2019 doi:10.1136/bmjopen-2019-03313

• This study found that primary care use by patients participating in a social prescribing pathway decreased significantly after 4 months.

European region of the WCPT statement on physiotherapy in primary care

European region of the WCPT statement on physiotherapy in primary care
Primary Health Care Research & Development, v20, e147 4 November 2019

• This statement has been produced by the European Region of the World Confederation for Physiotherapy (ER-WCPT) to promote the role of the physiotherapy profession within primary care, to describe the health and economic benefits to health systems and populations of having a skilled, appropriately resourced and utilised physiotherapy workforce in primary care services, and to illustrate how different models of physiotherapy service delivery are contributing to these health and cost benefits.