Primary care community hubs – what are they for, what do they look like and do they work? A rapid review.
Improving access to general practice and other primary care services is a key concern for policy-makers and practitioners. In the last decade several schemes, including the Primary Care Access Fund (PCAF), have been put in place at least in part to achieve this. The Primary Care Community Hub (PCCH) is one model to have been developed in this way and our review aimed to identify the aims, design model(s) and evidence for the effectiveness of these PCCHs in England.
Customized searches with a five year time limit were performed in MEDLINE and Google Scholar. Six websites (The Kings Fund, NHS England, NHS Improvement, NICE, the RCGP, and the BMA) were also searched. Titles and abstracts, and full papers were screened for inclusion by one researcher and checked by another. Included papers gave a descriptive account, or described a planned investigation or study of a PCCH in England. One reviewer will extract data into a customized table and assess the quality of included papers using the CASP and MMAT appraisal tools as appropriate, with verification of a 10% random sample by a second member of the team.
Our searches yielded 1777 citations, the majority of these from the six organisational websites. Forty full papers were assessed for inclusion and data is currently being extracted from 22 papers (9 national and 12 local evaluations, and one qualitative study). Two indicated evaluations were not received even with the use of FOI requests. The quality of the evaluations seen has been variable. Our assessment of PCCHs was complicated where such hubs have been set up concomitant to one or more other changes in local service delivery, with the changes having been evaluated as a whole. In addition, a PCCH may have been set up under one scheme (i.e. the PCAF) and then continued with modifications under a subsequent/ overlapping scheme with a modified goal such as the development of integrated care. Nonetheless, evidence for the effectiveness of specific PCCHs has been obtained in a small number of evaluations, with some common themes apparent.
Although evidence for the effectiveness of specific PCCHs has been obtained in a small number of evaluations, cost effectiveness and generalisability is less clear. In some evaluations it was not possible to specifically evaluate PCCH(s) as a component within a broader scheme of changes; and not all anticipated evaluations could be obtained. In order to ensure policy goals such as improved access to primary care services can be achieved effectively, it is essential that rigorous evaluation of all relevant changes are made and that such evaluations of publicly funded models are shared publicly.