In June 2015, the Cabinet Secretary for Sport and Health announced a new Primary Care Transformation Fund (PCTF) worth £20.5 million, to be allocated over three years, aimed at supporting the redesign of primary care services across Scotland, building towards a future where primary care is delivered by multi-disciplinary community teams in localities. A further £10 million was to be invested in primary care mental health services over 2016/17 and 2017/18 to encourage the development of new models of care to ensure that people with mental health challenges are provided with the most appropriate treatment, as quickly as possible, in the most appropriate setting. It was important to bring this together as physical and mental health are working collaboratively to look at services for people and not simply conditions.
The objectives of this Programme are:
- To pilot ‘models of change’ that support our objectives for holistic primary care
- Use the information gathered from the funded pilots to:
- Develop a clear understanding of what works across Scotland
- Identify areas for further investment and development. (This assessment will be achieved through an independent national evaluation as well as locally led improvement focused work)
As part of this process we have funded over 85 projects across Scotland. Integrated Joint Boards and NHS Boards have identified their priorities for improvement within their own areas. The test of change funded have been grouped into six themed work streams:
- multi-disciplinary models
- clusters & hubs
- mental health
- alternative/Improved Pharmacy/prescribing models
- supporting citizens
Within some of the test sites multiple work streams are being tested within one area. These provide a good characterization of the areas for change which will form the basis for shared learning.
Of these 85 projects, 31 are tests of change in mental health service delivery in primary care. Learning from these tests of change aim to address:
- the shortfall between need and demand for children and young people
- the variation in access to mental health services
- the inequity of treatment between physical and mental health
The proposed “model of change” focuses on the development of enhanced, intelligence-led, multi-disciplinary teams in each locality, with a clarified and strengthened role for general practice.
It aims to apply the lessons learnt from the pilots immediately on a local level; share the information and work with our stakeholders to create opportunities and remove barriers in making improvements and developing new ways of working in our Primary Care services.
It also aims to use our better understanding of the role of Multi-Disciplinary Teams (MDTs) to improve primary care service delivery across Scotland by providing timely and appropriate evidence to support the GMS contract and other Scottish Government policies.
We are currently supporting ‘models of change’ in all Health and Social Care Partnerships (HSCP). At the end of November we collected proposed aims and objectives of the proposed changes along with the measures that will evidence the expected outcomes. We have launched a knowledge network and this will be used to develop networking and sharing between the HSCPs.
Within the Scottish Government we have a small group of professional and improvement advisors who are supporting test of change pilots. This resource will be made available to local projects to support their change programmes. We envisage this as being quite light-touch, always pointing where possible to locally available quality improvement support. In addition, we also plan to deliver practical support to mobilise and engage partnerships, localities and clusters. For example, six monthly networking/learning exchange events and building a dynamic on-line community for discussion/ learning via a Primary Care Transformation “Knowledge Hub”.
Mental health policy colleagues are also working to develop quality indicators for mental health in Scotland, some of which would apply in primary care settings.
NHS Boards, Health and Social Care Partnerships, 3rd Sector organisations and the public.
Benefits of programme
The Primary Care and Mental Health Transformation fund is enabling a broad range of ‘models of change’ across Scotland. The programme will encourage the development, thematic change and support sharing and learning through the development of a Primary Care Transformation network. The funding of a broad range of different models in different settings will inform the future direction of Primary Care services. The Scottish School of Primary Care (sspc.ac.uk) have been funded to deliver the formal evaluation of this work.