Transforming primary care

Evaluating the Foundry Healthcare Lewes Primary Care Network (PCN)’s five year transformation project

Context for change

Across England, primary care remains an area requiring urgent transformation. Patients report frustrations around waiting times, access to care, staff shortages and a perceived lack of investment. Meanwhile, employees highlight concerns over working conditions, their ability to provide good quality care and a risk of burnout. These factors have all been exacerbated by the coronavirus pandemic (COVID-19).

The Fuller Stocktake report reviews how PCNs can be best supported within Integrated Care Systems (ICSs), with the aim of ensuring primary care remains the lynchpin of community-facing healthcare while also meeting the needs of people in their local area.

More recently, the Government has published its delivery plan for recovering access to primary care. The focus of this plan is to empower patients to manage their own health, implement modern access to practices, build capacity, and cut bureaucracy.

Evaluation and thought-leadership

On behalf of the Foundry, Health Innovation KSS commissioned Unity Insights to undertake a retrospective impact assessment of the model of care introduced at the Foundry. A thought-leadership piece was also developed to examine whether the Foundry model of care constitutes a local reply to the ambitions of the Fuller Stocktake report.

Evaluation

The evaluation found that:

• Over the five-year programme, improvements were seen in terms of patient outcomes, developing a sustainable workforce model and fostering a positive culture and working environment for staff through a challenging period for primary care services.
• A benefit-cost ratio found that every £1 of PCN funding invested in the interventions adopted by the Foundry is estimated to offer a return of £1.50 to the healthcare system.
• By adopting the Foundry’s model, it is estimated to result in a reduction of 12,480 non-elective bed days, 751 fewer A&E visits, 170 fewer ambulance conveyances and 720 fewer locum GP sessions over a three-year period.
• Foundry patients reported higher satisfaction regarding several aspects of care compared to Sussex ICS patients, including confidence in the healthcare team and the care they received. However, patient insights highlighted difficulties in accessing care.
• The Foundry staff felt the interventions had positively impacted the provision of care, noting the impact on patients (through improved triaging) and on staff (upskilling and broadening of responsibilities).

Thought-leadership

The thought-leadership piece (TLP) highlights challenges and enablers across the following areas:

• Building integrated teams in every neighbourhood;
• Working with people and communities;
• Improving same day access to urgent care;
• National environments for supporting locally driven change;
• Workforce models;
• New approaches to primary care estates;
• Importance of data

The TLP sets out how other PCNs can adopt the Foundry’s model by highlighting key conditions and principles for adoption. The TLP includes a checklist of the activities that PCNs should conduct first when looking to adopt the Foundry model.

The piece also explores how the wider system can support innovative models of care. Key activities include setting the strategic vision, shaping a positive narrative around the transformation in primary care and providing clarity and long-term stability about funding opportunities. ICSs can support this process by brokering relationships, facilitating cross-organisation collaboration, and providing expert assistance and training programmes.

The Foundry’s journey presents a roadmap for delivering integrated services using population health management and a dynamic workforce model to tackle the challenges of providing timely, appropriate and personalised care.