Primary care networks: are they fit for the future?

Smith, Judith; Checkland, Kath; Sidhu, Manbinder; Hammond, Jonathan; Parkinson, Sarah

doi:10.3399/bjgp21x714665

Cited by 11 publications

(12 citation statements)

References 4 publications

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“…In England, early evaluation of the 1,250 primary care networks (PCNs), that were established in July 2019, have also highlighted poor management and infrastructure support [24,25]. Indeed, repeated studies of primary care reforms in England note that adequate infrastructure and managerial support is a key determinant of outcomes [26][27][28]. In Waleswhere GP clusters were established in 2010 -similar implementation problems were identified [29] which resulted in the Welsh government allocating two tranches of £10 million, giving and extra £20 million being invested on a recurrent basis, with most clusters also being supported by a full-time, senior, non-clinical, project manager (A. Lawrie, personal communication).…”

Section: Relationship With Published Literaturementioning

confidence: 99%

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

et al. 2022

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Background: Primary care transformation in Scotland aims to improve population health, reduce health inequalities and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP contract though started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working. Aim: To explore progress in the implementation of the GP contract in Scotland in terms of MDT and cluster working. Design and Setting: Qualitative study with key national primary care stakeholders (PCSs) (n=6) and Cluster Quality Leads (CQLs) in clusters serving urban high deprivation areas (n=4), urban mixed areas (n=4), and remote and rural areas (n=4). Methods: Semi-structured interviews with thematic analysis. Results: There was general support for the initial aims of the new GP contract but all interviewees felt that progress on both MDT expansion and cluster working was slow, even prior to the pandemic. None of the CQLs (and few PCSs) felt that GP workload had reduced significantly, nor that the care of patients with complex needs had improved. Lack of time and poorly developed relationships were key barriers, as was a lack of relevant primary care data, and additional support (including guidance, administration, training, and protected time). Conclusion: Key PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.

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Section: Relationship With Published Literaturementioning

confidence: 99%

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

et al. 2022

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“…An explanation may be that professionals have more knowledge, skills, and trust to discuss items and plan actions closely related to the domain of primary care than those related to the more social domains [44,45]. Furthermore, to succeed in social actions or referrals to other settings and professionals, strong network relations are crucial, but may not be present or developed sufficiently during the course of the pilot study [44,45,53].…”

Section: Discussionmentioning

confidence: 99%

The Patient Centered Assessment Method (PCAM) for Action-Based Biopsychosocial Evaluation of Patient Needs: Validation and Perceived Value of the Dutch Translation

Smeets

Hertroijs

Kroese

et al. 2021

IJERPH

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The Patient Centered Assessment Method (PCAM) is an action-based tool that supports professionals to engage in a biopsychosocial assessment with patients and measure their needs. It is a promising tool for person-centered care. As the Netherlands lacks such a tool, a Dutch version was developed. Furthermore, we aimed to contribute to the relatively limited insights into the psychometric properties and value of the tool when used as part of a needs assessment in primary care. Confirmatory factor analysis was used to study construct validity and Cronbach’s alpha was computed to assess reliability. Furthermore, we interviewed 15 primary care professionals who used the PCAM. It was confirmed that each PCAM domain measures a separate construct, informed by the biopsychosocial model. The tool showed adequate reliability (Cronbach’s alpha = 0.83). Despite face validity concerns, the tool was mainly valued for measurement of patient needs and to facilitate action planning. Criticism of the PCAM pertained to a limited focus on the patient perspective, which is one of the crucial aspects of person-centered care. These rich, mixed-method insights can help to improve the value of the PCAM, as one of the few multifunctional tools to support professionals in holistic assessments.

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“…However, the same studies have identified a general lack of purposeful improvement activities within clusters, partly because of limited capacity for key tools including data analytics and quality improvement methods. In England, "flexible and enabling managerial support" (13) of collaborations has been found to support improved outcomes (14,15), but a "prescriptive, contractual" policy framework has been criticised for damaging existing collaborative initiatives (13). In Scotland, GP clusters have been relatively lightly managed by contrast, but the need for more capacity-building and training has been noted (11,12).…”

Section: Gp Clustersmentioning

confidence: 99%

Transforming primary care in Scotland: a critical policy analysis

et al. 2022

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Strong primary care is central to effective health systems, but both in the United Kingdom (UK) and internationally, primary care has proved one of the most challenging areas for health policy reform (1,2). Across the UK's four health systems, there are currently some strong resonances in policy ambitions, including broadening the multidisciplinary team to support general practitioners, encouraging place-based collaboration between practices, and innovating for quality improvement. However, especially when comparing England and Scotland, contrasting policy approaches to pursuing these goals reflect different governmental "styles of intervention" (3).In Scotland, where health policy was devolved to the Scottish Parliament in 1999, primary care has undergone continual evolution as policymakers have sought to improve the quality of care delivered, and to address underlying -and still stubborn -population health inequalities. The seismic, top-down reorganisations that have characterised recent English health policy (4) have been absent in Scotland. There have, though, been significant developments. The wider health system was reconfigured by Scotland's 2014 Public Bodies (Joint Working) (Scotland) Act which mandated the statutory integration of health and social care, creating new integration authorities on a legal basis(5). Then in 2018, a Scotland-specific GP contract was introduced for the first time, removing the Quality and Outcomes Framework (QOF) from Scottish primary care.Despite international interest, there remains relatively little peer-reviewed academic literature on Scottish health policy, as opposed to Scottish health services. One reason for this might be that Scottish reforms over the years of post-devolution health policy have been more incremental; lacking the 'big bang' system reorganisations we have seen in England (6). However, primary care in Scotland has been far from static: researchers have noted that the pace of layered reforms over the last decade complicates the potential to learn from and about specific policy interventions (7). We need new, and more nuanced conversations about how primary care in Scotland has changed, why, and to what ends. As a prompt for these conversations, we offer a critical summary of research on the Scottish reforms, contrasting the underlying approaches to reform taken by policymakers in Scotland and in England.

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Primary care networks: are they fit for the future?

Cited by 11 publications

References 4 publications

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

The Patient Centered Assessment Method (PCAM) for Action-Based Biopsychosocial Evaluation of Patient Needs: Validation and Perceived Value of the Dutch Translation

Transforming primary care in Scotland: a critical policy analysis

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