On the 14 April, the Government and NHS England announced two programmes aiming to improve primary care.
The first, the Prime Minister’s Challenge Fund, was in reality a re-launch. In October last year, GP practices were invited to bid for a share of a £50 million pot to improve access to their services.
This could involve extending opening hours; setting up systems for online consultations, using Skype for example; creating new services such as care coordination for people with complex needs.
Originally intended to fund around nine pilot sites covering 500,000 people, the Government has instead awarded it to 20 pilot projects covering 7.5 million people (though from the same size pot). The funding will last one year.
At the same time, they announced the Transforming Primary Care programme (TPC).
Originally framed as the ‘vulnerable older people’s plan‘ in July 2013, TPC is aiming to improve proactive, joined-up primary care of older people and those with the most complex needs.
It aims to do this by guaranteeing a ‘named GP’ for all people over 75, so people have clarity as to who is responsible for their care, and by offering extra support for the people with the most complex needs.
For example, GP practices will need to provide someone to coordinate a person’s care. They will need to offer rapid telephone access for people with urgent needs. Perhaps most importantly they will be expected to create a care plan in partnership with patients and their carers.
These services will be available from September 2014 for the 800,000 people with the most complex needs, the majority of which will be older people.
These two initiatives were never intended to be launched together, but they could end up being complementary. Expanding opening times into the evening and weekend, for example, could free up the time needed to properly assess and plan care with older people.
We must bear in mind that the Challenge Fund will reach around 1,100 GP practices, so it won’t be available everywhere.
And while the named GP for people over 75 must be available everywhere, the parts relating to care planning and coordination will be optional for GPs. However, we expect virtually all practices to take up the package of funding it is linked to.
Transformation may be a strong term to use in relation to these initiatives, but they are undoubtedly an important step forward for primary care services.
Proactive, person-centred care has long been an aspiration for primary care services. Keeping people well for as long as possible, particularly when living with multiple health conditions and complex needs should be a key priority for health services.
It is easy to think of the NHS as a service that responds to crisis, characterised by the busy A&E department or surgeons’ table. This is absolutely a core function.
However, it is equally important that the skills of the people that work for the NHS are put towards keeping people away from crisis; supporting them to stay as active and independent for as long as possible; and for those people that may rely on support on a more regular or even daily basis, providing care that is dignified and centred on goals that patients set themselves.
TPC starts to give some shape to this approach, and should be welcomed for that.
Age UK recently published a report on living with frailty, featuring a wealth of insights from the people experiencing it. We couldn’t say if the people featured would ‘qualify‘ for the extra support offered in the TPC, but the issues and aspirations they describe get to the core of what is currently missing from the NHS’s, and society’s, response to this group of older people.
You can find the report here, where you will also find videos of the older people involved talking about their experiences.
Over the next few weeks, we will feature a blog that discusses the themes that emerged from the research. Check back every Tuesday.