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Shifting the culture of care

Don Redding

Don Redding, Director of Policy at National Voices, talks about what he’s learned from visiting primary care network sites, and their potential to deliver person-centred, coordinated care in the community.

  • Primary care
  • Person-centred care

Primary care networks – what are they?

All over England a new layer of health and care provision is forming: the primary care networks.

I’ve been spending time with them, and the first thing to notice is the energy and enthusiasm for a new model.

Networks get a new contract with additional money and designated new staff roles, including a paid-for ‘link worker’ to help people find community support.

This enables a clutch of general practices – typically around six-eight, with a registered population of around 50,000 – to add scale to their work and to ‘network’ with other services, including adult social care, mental health, community health, and the voluntary sector.

Networks will face ‘out and down’ to their communities, not just vertically into NHS providers, taking a proactive approach to their population, and collaborating with others to solve people’s problems rather than just providing tests, prescriptions, diagnoses and referrals.

This is not new everywhere. Some GP federations and super-practices are already at ‘scale’ and, like Lakeside in the east Midlands, are providing new models of patient care.

The Primary Care Home model, sponsored by the National Association of Primary Care, has acted for several years as a pathfinder for person-centred care, focused on population health outcomes, and deploying an integrated workforce.

The social prescribing movement has spurred a generation of GPs and staff to think in terms of social and wellbeing support to their patients.

Improving wellbeing and building resilience

At this local level people can see the results of change quickly. I visited a medical group in Newport Pagnell whose director invested time simply reaching out and talking to any community group or local service provider she could find.

Rapidly the group’s building became the centre of new activities; staff satisfaction with finding new solutions for patients increased; and new projects sprang up.

When practices go out to communities, the rising tide of mental health need (evidenced in national reports about the stress and anxiety faced especially by young people and deprived communities) hits them in the face.

Newport Pagnell responded with a wellbeing programme offered by the local gym, with referrals from schools and youth groups, at minimal cost.

Elsewhere, at a Primary Care Home national event, a south coast federation described sending a GP regularly into a large secondary school to work alongside its pastoral staff on counselling, establishing peer support, and creating referral routes for students who otherwise would never present themselves to formal services.

Building community engagement

National Voices is seeking to help support these networks, using our knowledge of person-centred, coordinated care and the experience of our member charities.

We are encouraging the national programme to keep people and communities at the centre of PCN design; and helping to outline a ‘small steps’ development approach to community engagement.

We are also working with the Primary Care Home to assess what their 225 sites may need to raise their engagement levels.

PCNs are not big new organisations, they are a slim new layer of collaboration which could shift the culture of care.

Their energy and creative relationships need sensitive support, not performance management or an overload of unrealistic expectations.

And the framing is not yet complete. At a design day for the national ‘support offer’, few participants cited ‘universal personalised care’ in their vision – though it is a key element of the new service model.

Service users will want to know that care planning, support for self-management, and interventions such as health coaching and peer support will be available to help them achieve the outcomes most important to them.

Person-centred care still has a distance to travel.