Tracking everything that’s new in care models and progress of the Five Year Forward View. By integration reporter David Williams.


The week in new care models

Half a loaf is better than no bread at all

Simon Stevens has signalled a subtle but important shift in how new care models will be developed.

In his interview with me and Dave West last week the NHS England chief said he believed there was a huge appetite for scaling up general practice along the lines of “primary care home”, and that he would invest in and support the model next year.

He had much more to say about this than multispecialty community providers, and suggested that primary care home is where the “action” was likely to be over the next 12 months, while few areas would establish full blown MCPs any time soon.

So have national leaders given up on MCPs - and does this mean they are reining in their ambitions for scaled up primary care?

No – but they are being pragmatic and the emphasis is now shifting towards initiatives that will pay off quickly in many areas, rather than in a few places over several years. And, they are responding to signals from grassroots general practice, which is not overwhelmingly enthusiastic about the full blown MCP model in many areas, and in some cases is suspicious of it.

Although primary care home does not go as far as the MCP model, it is entirely compatible with it. In some circumstances primary care home could pave the way for an MCP or a PACS.

The particulars of primary care home will probably be familiar to anyone who has been thumbing through the primary care section of a sustainability and transformation plan. Not many STPs say “we’re going to do an MCP on X geography for a population of 250,000”. Several talk in vague terms about setting up an accountable care organisation. But many areas have plans to foster collaboration between GPs, setting up “hubs” serving a population of 30,000-50,000, providing an extended range of services via a more diverse workforce. The idea is that at that scale, primary care can provide a single point of access for all the services most people with long term conditions need.

These hubs, on that population footprint, are the building blocks of both MCPs and PACS. It’s just that MCPs and PACS do other stuff too, and wrap organisational and contracting structures around them.

What primary care home does not necessarily involve is new organisational forms, clever new contracts or partnerships with other organisations whom GPs don’t really trust. It can be achieved using existing practices, and GPs can continue to run the business. Although the model has been sponsored by NHS England in the form of a modest amount of transformation funding, it was worked up by the National Association of Primary Care. What all that adds up to is GP ownership: primary care home has the aura of being GPs’ own model, rather than something foisted upon them; GPs would continue to own their businesses; and GPs get to lead the future model.

Put another way: the barriers to setting up an MCP or PACS (contracting, organisational form, undeveloped relationships between various parties) don’t apply to primary care home. That means the model can be set up relatively quickly - if there is as much hunger for it among GPs as Simon Stevens thinks there is.

It is tempting to breathe a sigh of relief that primary care home doesn’t involve messing about with elaborate joint venture structures, assuring new organisations, innovative (a euphemism for untried and risky) contracts, and the dreaded public procurements. But only a masochist would get involved in any of those things if they didn’t offer an attractive prize: a simplified provider sector, the full integration of primary, community and acute care, long term contracts with fewer perverse incentives, and a structure that enforces a focus on population health.

Simon Stevens has recognised that this vision, which forms the core of the Five Year Forward View, is still a long way off in most places. The decision to emphasise and invest in primary care home next year is an acknowledgement that the whole NHS needs improved primary care as soon as possible. It is better to take a few important steps in the right direction today than wait – possibly forever – for everyone to take a giant leap.