What did we do?
Our research has demonstrated the impact of changes to the amount of time general practices are open and, as part of the process of carrying out the research, led to changes in the primary care strategy for Greater Manchester that is being implemented over the next five years.
How did we do it?
In 2013, as part of the Primary Care Commissioning Strategy for Greater Manchester, NHS England (Greater Manchester) chose to reserve some of its budget to fund a programme of ‘demonstrator communities’ in the region, with the aim of testing the various components of the newly developed strategy. The strategy describes its objective as “commissioning quality health services delivered as close to home as possible and in the most cost effective way. Our aim, over the next five years, is to work with our co-commissioning partners to deliver transformed out-of-hospital care for all people of Greater Manchester”.
In April 2013, following an open competition, six demonstrator communities (aligned to five clinical commissioning groups) were awarded funding totalling £2.1 million, with additional funds later being supplied to support continuation of the demonstrator communities’ activities until September 2014. The activities of each community differed significantly in their scale, scope and focus, and included implementation of proactive case management for care home residents, rapid response services and, notably across four sites, increased access (e.g. evening and seven day working) to general practice.
In December 2013, NHS England (Greater Manchester) commissioned the NIHR CLAHRC Greater Manchester to conduct an independent evaluation of the demonstrator communities, combining a process and outcome evaluation. Co-designed with NHS England, the evaluation aimed to identify:
- Whether the stated innovations and interventions could be effectively implemented and delivered in primary care
- How such innovation could be brought about what enabled, or disabled, such innovation
- The impact of the implemented interventions on key outcomes (e.g. on health service utilisation and patient satisfaction).
Importantly, the evaluation was designed in such a way to ensure that knowledge and learning gathered over its course was shared with, and across, the pilot sites in real-time, enabling them to adapt and refine their interventions ‘as they went’ in order to maximise their potential impact. Such a collaborative learning environment was fostered through close engagement with both NHS England and the demonstrator sites, as well as through regular meetings where stakeholders were invited to hear about the evaluation, discuss it and provide feedback as it progressed.
The final evaluation report was submitted to NHS England at the end of April 2015, but we produced several interim evaluation reports over the course of the initiative, to provide indications of the findings. This information was central to enabling demonstrator sites to refine their interventions ‘as they went’, and also to supporting key, time-critical decisions regarding future service design, commissioning and intervention roll-out.
The evaluation compared different models of extending general practice access (a key national priority), analysing key data concerning appointment utilisation and uptake, and examining the impact of this on secondary care service utilisation and patient satisfaction. Notably, our evaluation report precedes that of the evaluation of the national £50million Prime Minister’s Challenge Fund (PMCF), which also aimed to help improve access to general practice and stimulate innovative ways of providing primary care services.
Key outputs and impacts
- Three evaluation reports submitted prior to the final evaluation report provided invaluable findings to support key decisions concerning future commissioning and service design. These reports were provided in a range of formats and mediums, tailored to the end users
- The process evaluation identified six enablers of primary care innovation. These have formed the basis of a checklist, developed to guide commissioners and providers involved in future primary care service redesign initiatives, which will be spread as part of the implementation of the strategy
- The process evaluation identified several issues that have been taken forward as part of the wider strategic agenda. The findings have provided a fundamental basis for the development of primary care information management and technology, information governance and workforce strategies, and have supported the development and implementation of GP federations, by providing an insight into the impact of such organisational forms on the demonstrator activities
- Interim evaluation findings contributed to, and supported, the design of the successful Greater Manchester bids for the first and second wave of the PMCF, worth a total of £10.7million
- The process evaluation identified future lessons for individuals and organisations (e.g. NHS England) attempting to orchestrate innovation, particularly in relation to the design and governance of such initiatives that are yet to be spread more widely
- As a direct result of the evaluation findings, innovations and changes in service delivery, such as extended access to general practice, tested on a small scale as part of the demonstrator initiative, have been refined and implemented at scale.
At a regional level, the evaluation findings are being used extensively to support NHS England and the respective CCGs in meeting the newly established Primary Care Standard concerning access to general practice:
“By the end of 2015, everyone living in Greater Manchester who needs medical help will have same-day access to primary care services, supported by diagnostic test, seven days a week.”
Implementation of this standard within Greater Manchester has provided 2.6million people with access to general practice seven days a week. This is also one of the seven ‘early implementation’ priorities for the Greater Manchester devolution programme.
Building on our evaluation of the demonstrator communities, we are now working with NHS England to conduct an independent academic evaluation of the roll-out of seven day access to primary care across Greater Manchester.