Evaluating Primary Care Transformation in Scotland: Findings From Two Qualitative Studies

Problem

The Scottish School of Primary Care is evaluating primary care transformation across Scotland and has commissioned a number of projects to evaluate test of change pilots. Focusing primarily on projects funded by the Primary Care Transformation Fund, the Primary Care Mental Health Fund, and Out of Hours Transformation Fund, in order to provide evidence to support different models of primary care. Two Scottish Health Boards (NHS Lanarkshire and Ayrshire & Arran) were chosen by the Scottish Government as case study sites. New models are needed to address workload issues including staff shortages. In Phase one of this research we aimed to:1. Identify the new ways of working that are being tested in primary care 2. Understand the context in which the new ways of working are being tested 3. Identify which models seem to be working well, and why; and which are not working so well, and why 4. Identify new models of working which would be interesting for further analysis in Phase 2.

Approach

Phase 1 involved the evaluation of new ways of working in primary care in Lanarkshire and Ayrshire & Arran and identification of new models of working worthy of in depth exploration in Phase 2. Qualitative methods, underpinned by Normalisation Process Theory, were used in Phase 1 and included a review of approximately 198 national and local documents describing the projects alongside in-depth semi-structured qualitative interviews with 27 key respondents.

Findings

Phase 1 identified 12 new models of care in Ayrshire & Arran, and 41 in Lanarkshire. These target a range of populations and conditions, dependent on local contexts and needs. Key features across these tests of change include: (i) community engagement and information sharing; (ii) patient re-direction to health care professionals other than GPs; (iii) re-distribution of first point of care workload; (iv) development of professional roles, especially for disciplines other than GPs; (v) strategies to enhance primary health care clinician recruitment; (vi) provision of services closer to patients; and (vii) changing skill mix. New models meriting further exploration related to: Digital Health; Eyecare Ayrshire; Pharmacy First (community pharmacy prescribing for UTIs and Impetigo); HARP, Healthy and Active Rehabilitation Programme; and House of Care.

Consequences

We present an overview of the new models of care being deployed, identifying key implementation barriers and facilitators of new models of working in primary care and identified programmes for further exploration. There is a growing recognition amongst politicians and policy-makers that new models of primary care are required, drawing on new and different professional groups and working across primary health care and social care. As such, understanding which new ways of working are likely to become normalised and sustained is essential to inform future decision making in this arena.