Neighbourhood lessons from global healthcare systems

Plans for a neighbourhood health service seem certain to feature heavily in the forthcoming 10-year Health Plan. It is a policy agenda that PCNs are well placed to shape locally given the vital role they play in connecting primary, community, secondary care services and enabling collaboration between them.

For neighbourhood health services to take root and flourish, much depends on the quality and depth of the relationships between the legion of bodies providing local services.  

With this in mind, it’s useful to look at what other healthcare systems around the world have been doing to promote joined up thinking and working in neighbourhoods.

Recently published research commissioned by the Health Foundation from the International Foundation for Integrated Care (IFIC) explores this issue. Focused on care coordination at the primary – secondary care interface in the management of chronic conditions, the research examines the design and delivery of some of the most promising care models from across the globe.

The successes of two of these care models owe much to the work of local primary care networks in their respective systems. As such they offer valuable learning for PCNs in England striving to lead and support efforts to build neighbourhood health services.  

PCNs in Canada

The first such care model is the Alberta Diabetes Pathway – a system-wide screening and treatment approach in Canada that aims to manage type 2 diabetes patients in primary care as much as possible and avoid unwarranted secondary care interventions. The launch of Primary Care Networks in Alberta, which is credited with rebalancing the power relationship between primary and secondary care, has been crucial in paving the way for the model.

Set up as joint ventures between family physicians and Alberta Health Services (Canada’s first and largest province-wide integrated care system) Alberta’s 39 PCNs receive capitation-based funding to employ staff and deliver services to meet local priorities that they’ve identified, such as improving diabetes management.  

Through the Diabetes Pathway model, newly diagnosed patients are offered diabetes education on an individual or group basis by a PCN nurse. Family physicians, nurses and dieticians then work collaboratively to manage patients’ diabetes in the community. The service, which has been running since the 2000s, is underpinned by a set of standard clinical protocols and guidelines, a centralised system for managing referrals to diabetes education or speciality services, and a regional registry of patient data.  

PCNs in Australia

The other model, Keeping Well, is based in Northern Sydney in Australia. It aims to identify older people at high risk of an unplanned emergency hospital admission, and provide community-based care targeted at avoiding such admissions. High risk patients are found by GP practices using risk stratification tools and receive planned appointments with practice-based teams, sometimes with a geriatrician.

Care is planned jointly by the GP and geriatricians and details are uploaded to both practice and hospital records. Meanwhile, a practice-based professional, usually a nurse, ensures that the care is coordinated and the right information reaches patients and professionals in a timely manner. The model is supplemented by a collaborative approach by GPs and geriatricians to manage patients with the most complex needs, a hospital run home monitoring service, Hospital in the Home, and a multi-professional rapid response team serving residential care homes. 

Keeping Well is a product of new collaborative commissioning arrangements aimed at improving coordination between primary, community and secondary care, and ensuring that system-wide initiatives receive sustained funding. North Sydney Primary Health Network, which is federally funded, and the state funded Local Health District that oversees the hospital sector, were the prime movers in its commissioning and funding. Responsible for co-ordinating and integrating care and responding to gaps in service provision and capacity, North Sydney PHN has a key governance, oversight and programme management role in Keeping Well. Its work to foster collaborative working between individual GP practices has also been vital in creating a conducive context for a programmes like Keeping Well.   

Both models have had a positive impact. The Diabetes Pathway model has delivered reductions in hospital attendances and admissions, while Keeping Well, which was only set up in 2022, can also point to positive staff and patient experiences and some emerging evidence of reduced hospitalisation.

In the case of the Diabetes Pathway, a history of effective collaboration and mutual trust between the respective partners, which the PCNs have helped to promote, has been an important success factor. Similarly, Keeping Well relies on the presence of well-developed joint-commissioning and shared leadership arrangements between the PHN and its system partners.

The lesson here for England is that time spent building and developing inter-organisational relationships is not a luxury, but critical to the success of the neighbourhood health agenda and all such cross-system initiatives.  

Bryan Jones is Senior Improvement Fellow and Lukasz Zielinski is National Medical Director’s Clinical Fellow, both at the Health Foundation.