Government aiming to transform primary care

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.

Read more about health and wellbeing on the Age UK website 

Author: Tom Gentry

Policy adviser - health services @tomogentry

2 thoughts on “Government aiming to transform primary care”

  1. I am 87 and had a hip replacement operation. Despite pain in my joints due to arthritis I had been active until the beginning of 2013, but needed the op. as my hip kept giving way and making walking very difficult. Until then I used to walk everywhere and was very fit for my age. The operation was a success and I am so grateful to the wonderful surgeon and doctors. However, the aftercare meant that my stay in the ward afterwards was purgatory and by the time I returned home my immune system was so low that I had to take antibiotics for two viruses (cellulitis and an ear infection). I had not expected to be so weak and helpless after the op. Just making up a bed for myself when I was returned home left me exhausted. My body clock was all over the place and it took me ages to get back to normal, both with sleeping and eating. While in hospital I found there was no pain from the op. so I was very lucky to have such a marvellous surgeon and staff. However, a few of the nurses seemed to be too busy to care. I tried to keep a low profile and not be a nuisance, but that did not help. One night I needed to use the lavatory. I got up quietly and made my way there and back with a walking aid. However, on the way back a nurse in charge came charging out and said ‘Do YOU know what time it is? It’s 2 a.m. !’ I did not reply, but wondered what was I supposed to do anyway? Another time I was directed to a washroom by a nurse, yet when I went to use that room the second time another nurse ticked me off for ‘keeping another patient waiting’ by using ‘the wrong washroom!’ I never answered back as I realised I doubt I could do their difficult job. I think that a few of the nurses were so were so rushed that they were ‘burnt out’ so it was not their fault. There was kindness, such as nurses bringing me extra blankets and tucking me in when I was cold. However, several times I got ‘ticked off’ by nurses for no reason, as though I was a naughty child. For instance, one kind health assistant loaned me a pillow slip to cover my eyes so I could get some sleep, but when another night I asked a senior nurse could I borrow one as I could not sleep, she snapped, ‘If you were really tired you could sleep’ – so no pillow slip – no sleep that night! Yet this was the nurse who, soon after my operation, kindly asked me ‘Would you like some stronger pain-killers?’ I was nauseous the whole time I was there (5-6 days) so although the meals provided were good I could not face food or even a cup of coffee or tea. I managed a couple of bowls of soup and forced myself to eat a piece of toast and an occasional half a cup of milk. I needed to survive as I am a Carer of a loved one. I could not sleep because of the bright lights and the noise such as the beeps of patients pressing their buzzers for assistance. Even when returning home in the ambulance I was bilious and ill, but could not be sick as my stomach was empty. Ancillary staff, ambulance people, physiotherapists etc. were all outstanding and extremely helpful. I believe that any more cutbacks in nursing staff would prove disastrous. If you have to be admitted to hospital, remember to take a sleeping mask and ear-plugs with you – AND don’t be old!

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