TY - JOUR
T1 - Evaluating primary care transformation
T2 - Synthesis of findings from UK pilot project reviews
AU - McSwiggan, Emilie
AU - Ng, Lauren
AU - Donaghy, Eddie
AU - Huang, Huayi
AU - Gillies, John
AU - Henderson, David
AU - Thompson, Andrew
AU - Wang, Harry HX
AU - Mercer, Stewart
N1 - Funding Information:
This study considered the following three major UK primary care transformation programmes: Vanguards (England); Pacesetters (Wales); and National Evaluation of New Models of Primary Care in Scotland (Scotland). Launched by NHS England in 2015, the Vanguard programme aimed to provide patients with more personalised and coordinated care, by transforming working relationships within and between primary, acute, and emergency care.12 There were 50 Vanguard sites — discrete local or regional areas of health service provision — which were funded to trial new ways of working, based on their own analysis of local needs. These were supported by a £200 million transformation fund and a central National Support Programme to implement and evaluate their projects.12 Projects were centrally funded and evaluated for a maximum of 3 years.12 The Welsh Government allocated £4 million to pilot innovations in primary care (known initially as Pacesetters and Pathfinders, then just Pacesetters), from 2015–2018,3 with further funding tranches released in 2018, 2020, and 2022.13 Initial funding was allocated proportionately to all Welsh health boards by share of population.3 Some centralised support for implementation and evaluation was provided through Public Health Wales.3 The Scottish Government established a Primary Care Development Fund in 2015, providing £30 million of funding to trial new models of primary care.6 These 'tests of change' took place in every Scottish health board and were diverse in their design and focus in response to local needs or priorities.6 There was no centralised support for planning and implementing projects, but a nationwide evaluation took place after the conclusion of the pilot phase.6 Projects were funded for 2 years, from April 2016–March 2018.6
Funding Information:
This study was funded through a research grant from the Economic and Social Research Council (reference: ES/T014164/1). Emilie McSwiggan’s role in this research is independent of her PhD research project, which is funded by the Legal & General Group (research grant to establish the independent Advanced Care Research Centre at the University of Edinburgh). The funders had no role in conduct of the study, interpretation, or the decision to submit for publication. The views expressed are those of the authors and not necessarily those of Legal & General.
Publisher Copyright:
© This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
PY - 2023/6/1
Y1 - 2023/6/1
N2 - BACKGROUND: Pilot 'new models' of primary care have been funded across the UK since 2015, through various national transformation funds. Reflections and syntheses of evaluation findings provide an additional layer of insight into 'what works' in transforming primary care.AIM: To identify good practice in policy design, implementation, and evaluation for primary care transformation.DESIGN & SETTING: A thematic analysis of existing pilot evaluations in England, Wales, and Scotland.METHOD: Ten studies presenting evaluations of three national pilot studies - the Vanguard programme in England, the Pacesetter programme in Wales, and the National Evaluation of New Models of Primary Care in Scotland - were thematically analysed, and findings synthesised in order to identify lessons learnt and good practice.RESULTS: Common themes emerged across studies in all three countries at project and policy level, which can support or inhibit new models of care. At project level, these included the following: working with all stakeholders, including communities and front-line staff; providing the time, space, and support necessary for the project to succeed; agreeing on clear objectives from the outset; and support for data collection, evaluation, and shared learning. At policy level, more fundamental challenges related to the parameters for pilot projects, in particular, the typically short-term nature of funding, with an expectation of results within 2-3 years. Changing expectations about outcome measures or project guidance part-way through project implementation was also identified as a key challenge.CONCLUSION: Primary care transformation requires coproduction and a rich, contextual understanding of local needs and complexities. However, a mismatch between policy objectives (care redesign to better meet patient needs) and policy parameters (short timeframes) is often a significant challenge to success.
AB - BACKGROUND: Pilot 'new models' of primary care have been funded across the UK since 2015, through various national transformation funds. Reflections and syntheses of evaluation findings provide an additional layer of insight into 'what works' in transforming primary care.AIM: To identify good practice in policy design, implementation, and evaluation for primary care transformation.DESIGN & SETTING: A thematic analysis of existing pilot evaluations in England, Wales, and Scotland.METHOD: Ten studies presenting evaluations of three national pilot studies - the Vanguard programme in England, the Pacesetter programme in Wales, and the National Evaluation of New Models of Primary Care in Scotland - were thematically analysed, and findings synthesised in order to identify lessons learnt and good practice.RESULTS: Common themes emerged across studies in all three countries at project and policy level, which can support or inhibit new models of care. At project level, these included the following: working with all stakeholders, including communities and front-line staff; providing the time, space, and support necessary for the project to succeed; agreeing on clear objectives from the outset; and support for data collection, evaluation, and shared learning. At policy level, more fundamental challenges related to the parameters for pilot projects, in particular, the typically short-term nature of funding, with an expectation of results within 2-3 years. Changing expectations about outcome measures or project guidance part-way through project implementation was also identified as a key challenge.CONCLUSION: Primary care transformation requires coproduction and a rich, contextual understanding of local needs and complexities. However, a mismatch between policy objectives (care redesign to better meet patient needs) and policy parameters (short timeframes) is often a significant challenge to success.
KW - primary health care
KW - general practice
KW - transformation
KW - evaluation
KW - new models of care
KW - pilots
U2 - 10.3399/BJGPO.2022.0154
DO - 10.3399/BJGPO.2022.0154
M3 - Article
C2 - 36868787
SN - 2398-3795
VL - 7
JO - British Journal of General Practice Open (BJGP Open)
JF - British Journal of General Practice Open (BJGP Open)
IS - 2
ER -