Multi-Speciality Community Providers
Among the New Models of Care which NHS England propose two especially address the perennial question of service ‘integration’. That usually means ‘better coordinate’ – the idea of organisational integration by merging general practices with community health services and/or hospital services remains rather outré at present.
Primary and Acute Care Systems (PACs) and Multi-Specialty Community Providers (MCPs) are networks of organisations which differ (slightly) in that PACs focus more upon ‘integrating’ primary with secondary care, and MCPs more upon linking the range of primary care services: general practice, community health services and any of: mental health, community health, therapy, urgent care, social, voluntary and hospital services. National Institute of Health Research (NIHR) commissioned reviews of evidence about these models. Since a search for studies about MCPs so soon after they were announced yielded no hits whatsoever we decided as a proxy to review the evidence about earlier and existing MCP-like projects. The money and time available limited us to studies of OECD countries since 2013. We assumed the best of them would also report important earlier research.
Our main findings were:
- Multidisciplinary teams are the central mechanism for ‘integrating’ the range of primary care services aforementioned
- MCP-like networks can successfully manage referral routes between care providers
- IT systems can improve care planning and help divert patients – but only if the IT is well designed.
- Short-term, MCPs are more likely to improve patients’ experience of care than reduce costs
We made some encouraging and some less encouraging, findings for NHS England. As encouragement,
- Planned referral routes can indeed be used to divert patients from secondary to primary care
- Care planning for individual patients promotes preventive care and helps divert patients from secondary to primary care.
However, we found no evidence for – or against – the ideas that
- Voluntary sector involvement has much impact on demand management
- Demand management necessarily reduces costs (that’s heavily context-dependent)
What mechanisms underpin how organisations should work together to create an integrated system? Headline results of recent realist review of multi-speciality community providers
Professor Rod Sheaff
Professor Rod Sheaff, Professor in Health Services Research, University of Plymouth
Professor Rod Sheaffs’ research interests focus on the over-arching question: What are the relationships between organisational structures, production processes and policy outcomes in the health sector, and in public sector and 'third sector' organisations more widely?
His current and recent research projects include: Diverse Healthcare Providers: Behaviour in response to commissioners, patients and innovations, for the Department of Health Policy Research Programme: and, all for the NIHR Health Services and Delivery R&D Programme: From Programme Theory to Logic Models for Multispecialty Community Providers: A Realist Evidence Synthesis; Integration and Continuity in Primary Care: Polyclinics and Alternatives; and NHS Commissioning Practice and Health System Governance.
He has also researched health policy implementation and a range of models of care and of healthcare organisation both in the UK and a number of other countries, especially in mainland Europe.