Innovative models of care delivery in general practice

Our report, Understanding pressures in general practice, published in 2016, outlined the current crisis facing general practice in England, and we have continued our work monitoring these pressures.

However, the question remains: ‘What can be done about this crisis?’ There is the option of delivering more services, faster, within the current model, by finding more GPs, adopting new technologies and improving the understanding and management of patient flow. However, the realities of recruitment and retention challenges mean a significant increase in the number of GPs is unlikely. In addition, the changing health needs of the population, with growing numbers of people with complex long-term conditions, mean these approaches alone are unlikely to meet patient needs.

Instead, new delivery models may be needed, radically altering the way in which general practice operates and interacts with patients, meeting the needs of patients for acute phases of illness but also for the ongoing management of long-term conditions and for helping people to stay healthy.

The aim of the project was to look at examples of different delivery models of general practice from around the world; to assess the pros and cons of each and the potential to apply them in the English NHS context; and to develop a set of design principles to guide the development of new models of care for general practice as part of whole-system redesign.

What we did

The project explored a range of different models of general practice delivery from the United Kingdom and abroad, including:

• multidisciplinary team-based models that use a wider range of professionals – including mental health professionals – to provide primary care

• segmented models that are designed to address the needs of specific population groups

• in-practice segmentation models that organise work within a practice around different population groups

• community-centred models.

We did the following:

• described the nature of each model, considering the relevant contextual issues and what that might mean for implementing the model in the English NHS

• considered how the needs of separate groups of patients might be met in the different models

• examined any information on cost and outcome, including patient experience

• examined how the model addresses issues such as access, continuity of care and interactions with the wider health and care system

• examined how the model supports innovation and effective use of resources

• considered workforce issues such as the impact on recruitment, retention and working practices

• examined issues related to implementation, attempting to capture information about how the model was developed

• highlighted overarching themes and common features across different models, potentially developing a set of ‘design principles’ for good general practice models.

We worked with an expert advisory group of GPs, practice managers, other practice staff and patient representatives across England exploring their views on new models of care delivery and the barriers to/enablers of implementation in the English NHS. The expert group was also used to test the emerging design principles.

Key contacts

Beccy Baird, Fellow in Health Policy, [email protected]