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Primary care: partnerships in action

Updated 21 May 2014

1. Primary care – vital to delivering healthcare in today’s world

Healthcare providers around the world are seeking to manage the rising burden of non-communicable diseases against a backdrop of both growing and ageing populations as well as greater expectations of health services.

There is an increasing number of people with long-term health conditions such as diabetes and respiratory, heart and neurological diseases. The fastest-growing category of patients is those with multiple long-term conditions. The evidence shows that integrated care, centring most of this on high-skilled Primary Care, achieves the best results for these patients.

Many countries are fundamentally re-thinking the ways in which healthcare can be provided to improve patient outcomes, increase access and yet be sustainable. Strengthening and extending primary care services is a recognised approach to achieving these goals.

“International comparisons between industrialized countries suggest that the populations of countries with higher ratings of “primary care orientation” experience better healthcare outcomes and incur lower healthcare costs than populations of countries with lower degrees of primary care orientation”

Mark Friedberg, Peter Hussey and Eric Schneider in ‘Primary Care : A Critical Review of the Evidence on Quality and Costs of Healthcare’ Health Affairs; May 2010; 29, 5 766-772

1.1 Primary care:

• co-ordinates the care of the many people with multiple, complex health needs
• delivers care closer to people, increasing convenience, especially in areas remote from hospitals.
• is a first point of contact for patients to facilitate the early detection of illness, and thereby improves outcomes.
• provides a long-term perspective to support disease prevention and healthy lifestyles.
• provides more cost-effective treatment for minor illnesses and injuries than hospitals

The primary care systems for the 21st century are built on the foundations of:

• multi-disciplinary teams of healthcare professionals trained for family medicine
• suitable facilities and infrastructure, integrating digital healthcare, to provide a range of access options and support dispersed populations
• clinical pathways for consistent and effective care, with referral processes for specialist consultations
• information systems including electronic patient records to optimise clinical activity

2. Primary care in the UK

The UK is known around the world for the quality of its primary care. Access for all is a central tenet of the National Health Service (NHS). The General Practitioner (the family doctor) and their team is the most commonly used access point into the NHS. Primary care in the UK is the central part of an integrated and comprehensive system which provides continuity and co-ordination whilst acting as the gatekeeper for access to specialist hospital care.

Over the past decade, primary care in the UK has been transformed into an internationally leading, multi-disciplinary model to improve accessibility, patient outcomes and sustainability.

Primary care services are developed and delivered through partnership between the NHS and a wide range of companies with expertise across the healthcare spectrum.

“In cost-effective terms, i.e. economic input versus clinical output, …….. the UK was one of the most cost effective over the period [1979-2005]”

Nearly 300 million family doctor consultations per year take place in England alone

25% increase in family doctors working in the NHS in England between 2001 and 2011

18% increase in other practice staff between 2001 and 2011. (This includes nurses, midwives, health visitors, managers, administrators and others involved with direct patient care e.g. physiotherapists, chiropodists)

3. Primary care – vital to delivering healthcare in today’s world

Healthcare providers around the world are seeking to manage the rising burden of non-communicable diseases against a backdrop of both growing and ageing populations as well as greater expectations of health services.

There is an increasing number of people with long-term health conditions such as diabetes and respiratory, heart and neurological diseases. The fastest-growing category of patients is those with multiple long-term conditions. The evidence shows that integrated care, centring most of this on high-skilled Primary Care, achieves the best results for these patients.

Many countries are fundamentally re-thinking the ways in which healthcare can be provided to improve patient outcomes, increase access and yet be sustainable. Strengthening and extending primary care services is a recognised approach to achieving these goals.

“International comparisons between industrialized countries suggest that the populations of countries with higher ratings of “primary care orientation” experience better healthcare outcomes and incur lower healthcare costs than populations of countries with lower degrees of primary care orientation”

Mark Friedberg, Peter Hussey and Eric Schneider in ‘Primary Care : A Critical Review of the Evidence on Quality and Costs of Healthcare’ Health Affairs; May 2010; 29, 5 766-772

3.1 Primary care:

• co-ordinates the care of the many people with multiple, complex health needs
• delivers care closer to people, increasing convenience, especially in areas remote from hospitals.
• is a first point of contact for patients to facilitate the early detection of illness, and thereby improves outcomes.
• provides a long-term perspective to support disease prevention and healthy lifestyles.
• provides more cost-effective treatment for minor illnesses and injuries than hospitals

The primary care systems for the 21st century are built on the foundations of:

• multi-disciplinary teams of healthcare professionals trained for family medicine
• suitable facilities and infrastructure, integrating digital healthcare, to provide a range of access options and support dispersed populations
• clinical pathways for consistent and effective care, with referral processes for specialist consultations
• information systems including electronic patient records to optimise clinical activity

4. Primary care in the UK

The UK is known around the world for the quality of its primary care. Access for all is a central tenet of the National Health Service (NHS). The General Practitioner (the family doctor) and their team is the most commonly used access point into the NHS. Primary care in the UK is the central part of an integrated and comprehensive system which provides continuity and co-ordination whilst acting as the gatekeeper for access to specialist hospital care.

Over the past decade, primary care in the UK has been transformed into an internationally leading, multi-disciplinary model to improve accessibility, patient outcomes and sustainability.

Primary care services are developed and delivered through partnership between the NHS and a wide range of companies with expertise across the healthcare spectrum.

“In cost-effective terms, i.e. economic input versus clinical output, …….. the UK was one of the most cost effective over the period [1979-2005]”

Nearly 300 million family doctor consultations per year take place in England alone

25% increase in family doctors working in the NHS in England between 2001 and 2011

18% increase in other practice staff between 2001 and 2011. (This includes nurses, midwives, health visitors, managers, administrators and others involved with direct patient care e.g. physiotherapists, chiropodists)

5. Managing long term conditions

In the UK, primary care is fundamental to the NHS model for the management of patients with long-term conditions. It aims to maximise the number of people controlling their own health through the use of supported care planning. To achieve these goals, the UK has advanced the management of patients with long term conditions and is, therefore, well-placed to share its expertise in implementing:

• integrated teams of doctors, specialist nurses and allied health professionals working to evidence-based NICE guidelines and treatment regimens to improve productivity and efficiency
• training programmes for both professionals and patients
• public health campaigns to encourage more sustainable lifestyles, increase early identification of conditions and promote self-care
• case management systems, IT registers and call and recall systems which help track all patients with long-term conditions *incentive schemes linked to clinical outcomes

GPs and community services in the UK are have broad expertise in preventing and managing long-term health conditions to improve the outcomes for patients and their families and reduce the burden on health services.

Smoking amongst adults in England has decreased from 39% in 1980 to 20% in 2009 (a 49% reduction)

Mortality from ischaemic heart disease in the UK has decreased by two thirds (68%) since 1980

6. Telehealth

Telehealth is an important component of the UK’s long-term care system. The partnership between the NHS and the commercial sector in the UK focuses on implementing telehealth systems integrated effectively with primary care services to provide proven benefits for patients with long term conditions.

The world’s largest randomised controlled trial of telehealth was recently completed in 3 areas of England, and demonstrated significant outcomes during the 2 year trial period including:

• 45% reduction in mortality rates
• 20% reduction in emergency hospital admissions
• 14% reduction in elective admissions
• 14% per cent reduction in bed days
• 8% reduction in tariff costs

Equipment suppliers and service providers are now working with the Department of Health to ensure that UK telehealth services are rolled out cost-effectively and in a manner that will benefit everyone.

7. Primary care partnerships in action

7.1 Primary care training in India : BMJ Masterclasses for GPs

BMJ Masterclasses are the BMJ Group’s programme of live educational meeting that were launched in 2006 to help busy doctors keep up to date with the latest evidence, guidelines and best practice in areas most relevant to them. Since then over 13,000 doctors have attended in locations all over the UK and other parts of the world, including India.

Each BMJ Masterclass is interactive and case-based, and gives doctors the opportunity to learn directly from leading speakers, ask questions, and network with the experts and their peers.

In June 2011 the first BMJ Masterclass for General Practitioners (GPs) in India took place when an audience of approximately 1500 participated in a video-conference meeting.

The Masterclass was broadcast from London to Mumbai and from there to over 40 centres around India simultaneously. Some centres had two way communications, enabling participants to interact directly with the speakers.

The Masterclass consisted of three sessions on cardiology, respiratory medicine and paediatrics. The speakers were all leading UK doctors and each session lasted for one hour, including time for questions.

Continuing medical education isn’t mandatory in India However, attracting 1500 Indian GPs to participate in the Masterclass demonstrated that sharing UK expertise under the auspices of a respected organisation such as the BMJ Group, is a type of education valued in a primary caresetting in India .

7.2 Improving Access to primary care services : DMC HealthCare

DMC Healthcare is a UK based healthcare provider specialising in primary and community care. Established 40 years ago, the company has evolved into a sector-leading healthcare organisation with a wealth of experience in transforming patient services to improve choice and bring high-quality care closer to home.

DMC Healthcare has been at the forefront of establishing new services on behalf of the NHS, including local walk-in health centres. Walk-in health centres were established in 2009 as part of an initiative to increase access to healthcare, opening every day of the year for 12 hours each day.

DMC Healthcare has established 3 walk-in centres, which it delivered simultaneously in a timely manner using its expertise in patient centric service delivery and facilities management, including:

*design of premises to meet the requirements of the centre *commissioning the facilities *recruitment of doctors, nurses and administrators *staff training in advance of the centres’ opening *a campaign to inform the public of the availability and benefits of the centres

DMC Healthcare’s approach has been highly successful. Over 15,000 patients per centre were seen in the first year, all the quality service indicators set by the NHS were achieved and it received plaudits from the health authority and Government ministers.

DMC Healthcare is now taking its experience of providing NHS Services to other countries, with its first clinic in India opening in 2013.

7.3 State-of-the-art facilities developed in partnership with local communities: the Guildhouse Group

The Guildhouse Group works in partnership with the NHS to develop primary healthcare services that reduce pressure on secondary care by offering rapid access to diagnostics, treatment and the safe management of chronic conditions outside of a hospital environment. Their approach to working with local communities to redesign services, and the resulting facilities, are used as examples of best practice for the NHS.

Guildhouse specialises in long term public and private sector partnerships, offering a “turnkey” solution covering all aspects of creating modern health facilities to the highest international standards:

• high level strategic planning and needs assessment
• early viability and appraisal
• securing funding
• service redesign
• specification and procurement
• delivery and operational management of buildings

Overseas, Guildhouse works with the best international companies to tailor proposals to meet needs of the specific region. Local joint ventures are established to ensure projects bring investment and skills to local people. Their most recent joint venture, “Saudi-British Healthcare”, will bring UK and Saudi expertise together to offer Gulf Co-operation Countries a new partnership-based approach to public sector investment in health services.

7.4 Community healthy living centre, Thetford, Norfolk

This 2,200m² integrated centre developed by Guildhouse is cited as an exemplar for community engagement by Community Health Partnership. It incorporates:

• a GP Practice
• child development and specialist community services
• rehabilitation
• dentistry
• podiatry
• minor surgery
• outpatient clinics
• diagnostics including digital x-ray
• community mental health services

The clinical services were completely redesigned to work around patient need, leading to unplanned services being clustered around the main entrance, appointment services around a second waiting atrium and administrative areas on the first floor.

8. Why choose UK companies and organisations as partners to develop primary care services?

UK companies work as partners with the NHS, the world’s largest healthcare system with the most developed primary care service, producing some of the best health outcomes for all citizens at good value. They are experienced in working in an integrated system which provides treatment to all citizens with a multidisciplinary team in each GP practice. There are numerous potential partners within the UK to help countries gain from the UK’s experience and enhance their own primary care infrastructure.

The UK has internationally acclaimed design, build and operating companies, often partnered with the NHS and experienced in producing unique and culturally appropriate community based centres for primary care.

The UK has some of the most sophisticated health data, analysis, planning and programme implementation systems in the world. Expertise is available to ensure you get the right service, workforce and facilities to meet your population’s needs.

Universal services require compatible information systems that support the clinician and the patient whilst gathering essential management and population data – the UK supplies sophisticated systems for primary care and public health.

The UK is at the forefront of implementing community-wide telehealth, telecare and mHealth systems and UK consortia are able to implement solutions optimised for individual countries and healthcare systems.

UK training for medical, nursing and allied professional staff is recognised world-wide as producing top class professionals and researchers.

To find out how Healthcare UK can assist you to access the expertise available within private companies, the NHS and academia, please email us at healthcare.uk@ukti.gsi.gov.uk