Evaluation of New Models of Primary Care in Scotland: Lanarkshire Case Study (original) (raw)

The views, information, and opinions expressed in this report are solely those of the authors and do not necessarily represent those of the University of Glasgow or the study funder, the Scottish Government. They are based on the information provided by the identified key informants who participated in this case study and may not necessarily represent potential key informants who were either not identified by the study recruitment strategy or who declined the invitation to participate in the case study. iii Key Messages NHS Ayrshire & Arran (A&A) Case Study Findings: A strategic approach was adopted by NHS A&A whereby different funding streams were used, either individually or in combination, to develop and implement 12 tests of change in line with its vision for primary care in the future. Some operated across all three local Health & Social Care Partnership (HSCP) areas, while others operated in a single site. Some built on previous work, while others were new initiatives. In terms of focus:  7 tested redistributing GP workload by redirecting patients to other professionals/ services as the first point of contact-Musculoskeletal (MSK) Advanced Practitioner Physiotherapists, Advanced Nurse Practitioners (ANPs), Eyecare Ayrshire, Independent Pharmacy Prescribers, Pharmacy First, Community Phlebotomist, and the Stewarton Public Information and Engagement Pilot.  3 tested models of multidisciplinary team working/integration of care-Integrated Urgent Care, Community Connectors, and Healthy Active Rehabilitation Programme (HARP).  1 tested a scheme to encourage early career GPs to work in A&A-GP Recruitment  1 tested an approach to promote patient self-management-House of Care (HoC) Most tests of change were operational by January 2018 when four were selected for more indepth study (deep dives): Eyecare Ayrshire, Pharmacy First, HARP and HoC. Some short-term outcome measures had been collected, such as number of patients seen by community-based services. Less attention had been paid to developing measures for monitoring their impact on patients' care journeys, GP practices and other parts of the health/social care system, and health inequalities. Implementation was facilitated by dedicated funding and time to develop the service, preexisting relationships, and if the service built on existing developments. Implementation and sustainability was challenged by the absence of committed future funding, buy-in from staff, and underdeveloped IT systems to monitor activities and share information. The identified facilitators and challenges resonated with the published, international evidence. Key informants reported early positive impacts of the tests of change on access to services (Eyecare Ayrshire and Pharmacy First) and on staff development and satisfaction (Eyecare Ayrshire, Pharmacy First and HARP). Implementation of House of Care was sporadic, and there was evidence that this test had not achieved widespread buy-in from practitioners.