Innovative Models of General Practice

Optional wording for policy briefings: A policy briefing is available for LKS staff to share in their organisations.  Produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust.  Feel free to reproduce it (with acknowledgement).

What does this mean for libraries? 

This report would be of interest to library staff supporting General Practice, Community Services and Clinical Commissioning Groups. Library staff may be involved in:

• Providing evidence to enable service and quality improvement.
• Negotiating access to resources and services if practices merge or grow in size.
• Conversations about how care is provided, facilitating access to evidence to underpin these discussions.
• Ensuring equitable access to high quality resources exploiting collaborative purchasing opportunities as available.

Source: King’s Fund

Link to main document 

Date of publication: June 2018

Summary of driver:

The paper considers innovative models of general practice being delivered in  the UK and internationally:

• Team-based working;
• Digital innovations;
• Community-centred approaches;
• Segmentation;
• New roles in general practice;
• Whole-system redesign.

Case studies and lessons learnt are provided for each model. The report suggests that the following features will be important for future designs:

• Building and maintaining strong relationships;
• A shift from reactive to proactive care;
• Using technology;
• General practice working within a wider health system;
• Supporting general practice to change.

The report concludes by making recommendations to general practice, system leaders and commissioners and policy makers.

Provision of community care: who, what, how much?

A Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

A large proportion (39%) of the contracts for community provision are held by private providers, with a further proportion held by charities. Library provision to these groups is likely to be difficult to arrange due to the effort required to prepare SLAs with each provider, with many of these providers holding just one contract.

Source: The Health Foundation

Link to main document

Publication format: PDF

Date of publication: May 2017

Summary of driver:

This paper analyses the community care contracts held by clinical commissioning groups (CCGs) in England. NHS providers held more than half of the total annual value of contracts in the sample, while private providers held 5% of the total annual value, but 39% of the total number of contracts issued. Private providers tended to hold much smaller contracts, with 6 in 10 holding contracts with a combined value of less than £100,000. Additionally, most held just one contract.

Key features of driver:

• Successive governments have wanted to increase the use of community care relative to acute care
• BUT community care still only accounts for one in every 10 pounds spent by commissioners
• Recently spending on community care delivered by non-NHS providers has increased substantially
• BUT not many people know who are providing these contracts or what size they are
• Investment in community provision is central to the Five year forward view, leading to 14 multispecialty community provider (MCP) vanguards testing new ways of delivering community care.
• NHS providers hold over half (53%) of the total annual value of contracts awarded for community services
• Other contracts are provided by:
  • GPs
  • Local Authorities
  • Charities
  • Private Companies
• Of the contracts studied by the Health Foundation private providers held 39% by number but only 5% by value
• Private providers tend to hold much smaller contracts – most held just one
• The majority of very large contracts were held by the NHS

Primary audience: Commissioners, community healthcare providers

Date last updated: August 2017

Due for review: August 2018

Group member responsible: JC

Tackling health inequalities: the case for investment in the wider public health workforce

Title of driver: Tackling health inequalities: the case for investment in the wider public health workforce

Source: Royal Society for Public Health (RSPH)

Link to main document

Publication format: PDF

Date of publication: June 2014

Summary of driver: A proposal to engage professionals working outside the public health sector, to harness their skills and motivation in order to positively impact public health in their communities. The report argues that through the promotion of healthy behaviour and encouragement of healthier lifestyles, health inequalities within local communities can be addressed which could in turn help to reduce the national incidence of lifestyle-related disease and safeguard resources in the NHS.

Key features of driver:

• The report highlights the pressures that are placed on the welfare system, the economy and social justice, with a cost to the NHS alone of around £5.5 billion (Frontier Economics. Estimating the Costs of Health Inequalities: A Report Prepared for the Marmot Review. London: Frontier Economics Ltd, 2010);

• The ‘wider public health workforce’ is discussed and defined as: any organisation or individual, who is not a professionally qualified public health specialist, but has the ability or opportunity to positively impact public health;

• 5 health initiatives are discussed and their effectiveness assessed in the context of: health outcomes, social benefits  and financial costs, benefits and sustainability) in tackling health inequality and encouraging healthier lifestyles: (1) health trainer service (funded community-based), (2) health champions initiative (community volunteers), (3) Making Every Contact Count’ (health promotion within organisations), the role of non-health professionals and (4) the creation of ‘healthy settings’ (schools and universities);

• The report comments that each stakeholder group (trainers, champions and clients) report a wide range of benefits that extend beyond simple improvements to physical health – improved mental well being, increased social interaction, higher levels of community cohesion and improved career prospects;

• Barriers to achieving change are described with 2 areas of particular concern being: the ability of the workforce to integrate with ‘hard-to-reach’ groups and the need for greater research  particularly into the extent to which behaviour change is sustained and the cost-effectiveness of programmes.

Primary audience: Local Government Authorities

Impact on library policy/practice:

• Opportunity to work collaboratively with colleagues in Public Health England to raise awareness of the wider public health workforce initiatives and communicate this to healthcare staff in primary and secondary care, for them to promote to patients and families;

• Opportunity to liaise with colleagues in public libraries to offer an evidence-base (literature, displays, talks) for their library users; showing how positive health outcomes and improved quality of life can be achieved by small changes in lifestyle e.g. better diet, regular exercise, engaging in community recreation and health education schemes;

• Commitment by library and knowledge service managers and resource librarians to incorporate a selection of health promotion and ‘healthier living’ resources into library stock and promote widely within our NHS organisations;

• Support Health Education England events in our regions e.g. Health Education Week to raise awareness of healthier lifestyle choices which can have a positive impact on the health and wellbeing of our local communities; families, friends and neighbours.

Date last updated: September 2014

Due for review: September 2015

Group member responsible: ME

Transforming Primary Care: Safe, Proactive, Personalised Care for Those Who Need it Most

Title of driver: Transforming Primary Care: Safe, Proactive, Personalised Care for Those Who Need it Most

Source: Department of Health and NHS England

Link to main document 

Publication format: PDF

Date of publication: April 2014

Summary of driver: 

‘Transforming Primary Care’ sets out plans to improve primary care services for older people and those with long-term conditions, providing personalised and pro-active care.

All people aged 75 and over will have a named GP, and services will be coordinated around the patient by improved communication with different teams e.g. A&E, care homes, mental health etc.

From September 2014, the Proactive Care Programme plans to offer 800,000 people with the most complex needs a personalised programme of care and support by their GP. Patients will also be supported to take control of their own care through technology. The Better Care Fund will support the integration of health and care services.

By 2020 an additional 10,000 primary and community health and care professionals will be in place to support the shift in care, and some of this be through return to practice programmes.

There will be better recognition of the role of carers, and the Care Bill will make it mandatory for local authorities to assess their needs for support.

There will be a revised training programme for GPs, to include an emphasis on working in teams, and care of older people. Post-graduate training for nurses working will older people will be developed, and Care Certificates will be introduced for health care assistants and social care support workers.

Key features of driver:

• More focus on out-of-hospital care
• Better integration of primary and community health services, acute care, mental health and social care
• Increased training and education to support the needs of the elderly and those with complex health needs

Primary audience: Commissioners, primary and community practitioners, Health Education England

Impact on library policy/practice: 

As staff move across traditional boundaries, there needs to be recognition of the need to fund libraries to support staff working in or across all the relevant organisations, including social care.

There could be impacts on funding from the acute sector if there is a major shift to primary and community care.

There may be opportunities to market ourselves as being able to support primary and community staff undergoing training to support older people and those with complex needs, and also to support healthcare assistants and support workers undertaking the Care Certificate.

If we are to increase the level of service we provide to staff working off-site, we may need to look at how these services are delivered, such as using the changes in copyright law to make requesting articles easier. We also to consider whether technology can help us deliver services remotely, for example using screen sharing software to provide assistance accessing online resources, or increasing the availability of ebooks that can be downloaded to mobile devices.

Date last updated: June 2014

Due for review: June 2015

Group member responsible: JC