September Month in Review/Last Chance to Sign Shared Principles 

Dear Colleagues and Friends,
  
In early September, I spoke at the U.K. National Health Services (NHS) EXPO in Manchester, England. I met with British leaders eager to re-invest in primary care and wanting to understand the successes and failures of the 10-year American effort to design, implement, and continuously evolve the Patient Centered Medical Home (PCMH). 

Simultaneously, American policy leaders are seeking to learn from their British counterparts about how their system links primary care to services in the community to better address the social determinants of health. 

The latest rendition of the NHS Five Year Forward View has signaled an intention to move towards accountable care systems to foster medical and population health (social care) integration by better aligning their payer (commissioning) and provider functions. Much of the 2017 NHS Expo was devoted to delivery and payment system transformation as well as the health technology infrastructure needed to support this wholesale change.   

The newly launched Primary Care Home (PCH) model in the U.K. brings additional attention to primary care, with a model that has four characteristics: first contact for all healthcare needs, person-centered and continuous over a lifetime, comprehensive for all common population needs, and coordination with more uncommon integrated care (e.g., specialty or tertiary care).  

After being successfully piloted, the British PCH has been rolled out to nearly 200 sites in England, covering 14 percent of the population. Each PCH is focused on building a team of approximately 150 different types of caregivers and community service providers to serve a target population of between 30,000 and 50,000 patients. The idea is that this design is large enough to provide scale, particularly for population health–based efforts, but still small enough to provide personalized care. Initial results suggest reduced ED visits (accident and emergency) and prescribing, improved staff recruitment and retention, and enhanced patient satisfaction.
 
The creation of the U.K. PCH and the work to spread the model is being spearheaded by the National Association of Primary Care (NAPC), a U.K.-wide membership organization for primary care professionals. Leaders from the NAPC visited Washington, D.C. in May 2017 to meet with PCPCC members and leaders to learn in more depth about the PCMH and Accountable Care Organizations (ACOs). Their collective reflections comparing reform of the two health systems on either side of the Atlantic are captured in a report, Providing Accountable Care: Comparing the Delivery of Primary Care in the UK and USA through Accountable Care Systems and Organisations, which was released at the September EXPO.

My major takeaway from my trip across the pond is that although the healthcare of the U.K. and the U.S. differ in the way in which care delivery is organized and paid for, leaders from both continents are motivated to achieve better patient outcomes while making care more affordable, and they see primary care transformation as being foundational in doing so.  




Ann Greiner, MCP
President & CEO