The Primary Care Home Warrington

What is it?• The Primary Care Home is a Population base for provision that

allows health and social care, and care coordination professionals to integrate in a primary care home setting around registered lists

• Allows commissioners to build in additional services around existing Practices relevant to their populations e.g. wider Primary Health Care Team, mental health, diagnostics etc., extended access

• Allows individual Practices to collaborate as they see fit to deliver best care for their registered lists

• Enables new investment around primary care registered lists to improve Practice workload and enhance professional job roles

Why are we doing it? Background – the primary care priorities of the CCG membership – top ten Jan 2013

• Access, demand and capacity• Medicines management and prescribing• Nursing and residential homes• Primary care quality – what is the ‘Warrington Offer’• Whole system/right care – role of primary care in the effective utilisation

of the whole system resource through system integration• Complex care including long term conditions (and cancer rehab interface)• Promoting prevention and self-care• Mental health• Workforce• Public engagement and communications in primary care

Vision ….

The system agreed the central challenges for both providers and commissioners are:

Warrington Vision Event- June 2013

How to

coordinate care

around the needs

of individuals

How to engage our communities

in healthy behaviours

around the needs of individuals

How to ensure right care – right place – right professionalensure right care – right place – right professional

How to make the best of the

resources that we have

What do people want?

Better support for people with long term conditions

More investment in community & primary

health services

Better support for people’s social care needs

Primary Care as the foundation

9 out of 10 patient contacts with the NHS

are in primary care

GP’s Registered Listis key

Primary care in system transformation

• Nine out of ten contacts happen in primary care. The ability to deliver effective care coordination is dependent upon the active engagement of primary care and the realisation of the full potential of the position of primary care as owners of the registered list, thus:

• Whole system transformation is required both to improve working lives and to deliver health and wellbeing gains

• Primary care is the home of care coordination• Other parts of the system need to be integrated around primary care to support

the GP/PHCT as the patients’ health advocates and primary care home• Key worker/care coordinator/MDT roles are central to operationalizing these

principles• Continuing with the current patterns of delivery and doing nothing is not an

option in primary care given the major pressures of workload reported in the Warrington Primary Care survey (January 2013)

• The ‘primary care home’ is a concept that the Primary Care Programme Group believe offers a key building block to deliver these transformational outcomes.

Our map to the future - overview(Visual representation of vision – not to scale – there will be 8 Primary Care Homes)

Paediatric Acute Response Team(PART)

Primary Care Home Delivery Team

‘Primary Care Home’

(Multi disciplinary team including community nursing/mental

health/care coordinator/GP for nursing homes etc.)

Clusters of Practices work collaboratively; other

provider services refocused around the

registered list

Non bed-based acute services

Intermediate Care Facility (bed bases)

Hospital Services GP Practice

GP Practice(With Care Coordination)

The concept of the ‘Primary Care Home’

• The idea of the ‘primary care home’ is often referred to in connection with international health policy research and US literature. The research of Barbara Starfield has been particularly influential in understanding the impact of primary care on the wider system and on population health. Starfield defines primary care as:

• That aspect of health services that assures person focussed care over time to a defined population

• Accessibility to facilitate receipt of care when it is first needed• Comprehensiveness of care in the sense that only rare or unusual

manifestations of ill health are referred elsewhere• Coordination of care such that all facets of care (wherever received)

are integrated 1.• Starfield, B. J.Epidemiology and Community Health

Criteria for proposed PC Homes• Cohesion of population need (age/deprivation

profiles/disease burden etc.) – Consultation document details demographic profiles

• Geographical factors including proximity but also travel factors (bus routes etc.) and cultural associations (where do people travel easily to a centre, where could additional services be placed to be easily accessible)

• Populations close to 30,000 where possible representing evidence on size of population where a community based multidisciplinary primary health care team (PHCT) could be focussed at appropriate scale

• Population base allows health and social care, and care coordination professionals to integrate in a primary care home setting

• Practice units within a wider team of practices in collaboration, benefiting workforce and communities

• Extended access • GPs with specialist skills• Separates acute and complex care,

manages complex care proactively with MDT input around PC Home

• Has shared care coordination resources (key workers or care coordinators) incorporating health and social care

• Has Active Case Managers• Has rapid access diagnostics• Has more ambulatory care

available dependent on the needs of that population

• Has expanded community based mental health services

• Has shared nursing home services• Provides a home for dedicated

medicines management • Provides more scope for self-

management and primary prevention support, integrating with local government and third sector provision

What could this do for Warrington?

Proposed Clusters March 2014 Consultation