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Internationalising primary healthcare

May 6, 2022
by Healthcare World

Sarah Cartledge discusses the importance of primary healthcare with Jyoti Mehan, CEO Health Care First Partnership.

The UK’s National Health Service or NHS has often been a conundrum for international healthcare providers. They admire the concept of free healthcare at the point of delivery, but can misunderstand this complex organisation which is divided into 223 hospital trusts, 135 clinical commissioning groups, 1300 primary care networks (PCNs) with around 10,000 general physicians known as GPs, and several other groups that oversee its work in different ways. So it’s not a model that is easily replicable, but it has more than 70 years of learning that can be adapted on a global level.

The first port of call in the UK is the general practice service, offering a care navigation system that can resolve varied issues without involving secondary intervention. But in many countries across the world, the cultural norm is to take any medical problem to a hospital where it can be dealt with, regardless of urgency.

So in these countries, introducing the GP system could meet resistance through lack of understanding and a mismatch of system incentives. This is where Jyoti Mehan and her colleagues at Health Care First come in, offering a consultancy package for overseas providers that embraces the ethos of general practice while ensuring it aligns to cultural nuances and demographic requirements to enhance the provision of healthcare.

Sharing expertise

Health Care First is an award-winning atscale provider of general practice, serving more than 32,000 patients across 7 sites in the north east of England. “We feel we can add value by sharing our learnings, many of which have been achieved through trial and error and through circumvention,” says Jyoti. “As a result we can help create something fit for purpose, rather than copying and pasting the NHS model.”

The organisation has a large team with a diverse background of clinicians and MDTs, along with skilled professionals in change management, operational model design expertise and digital transformation. “We bring industry expertise, international expertise and first rate clinical expertise we can share,” Jyoti stresses. “Many of us have worked at all levels of the system – commissioner, investor, provider, operator and regulator – so we understand how it works and where the challenges lie.”

At the heart of their work lies the culture of putting the patient first. It may seem an obvious focus, but in such complicated systems the patient may not always be at the forefront of decision-making. “The core elements of patient care are agnostic. Other decisions need to be nuanced to country culture and region. Given our diverse UK population we are skilled to be able to unpick this and understand these very specific requirements, and help shape something that’s fit for purpose.”

Patients and providers can understand the concept of family medicine, but it’s not always easy for onlookers to understand the concept of general practice and what it can deliver. “However, if you take it out of the prism of the NHS you can easily align it to an in-country structure to maximise its benefit,” says Jyoti. “If, for example, the first point of contact within a hospital looks like and feels like a hospital service to a patient but is in fact is what we call General Practice, then in this way it would integrate GPs without impacting people’s perceptions. So the learning is not to put the GP service where you think it should be, rather to allow people to follow their path and then build the pavement.”

Digital integration

In regions or countries where healthcare organisation is in its infancy, there exists the unprecedented opportunity of building a system for current purpose and need which includes embracing digital through a complete digital healthcare system. “I would advocate a fully integrated digital model of primary care in the first instance, delivered in the hub and spoke model, because access is incredibly important,” she continues. “Facilities would need to be in key areas, enabling people to access them relatively quickly and linking into other providers including acute care and community services. This enables patients to access a service in the way they need to use it so they are not bouncing between systems or having to wait weeks when all they wanted was a blood test.

“We need to integrate this concept into a bricks and mortar structure to provide a seamless user journey – either through walk-ins or as digitally-enabled rooms providing a cost effective service by accessing a wider workforce,” she continues. “A patient could walk in and use a digital facility and if they need their bloods done they can walk out of that room and see a haematology assistant immediately.”

In remote or large geographical areas, digital integration is the key. “Here the hub and spoke model works incredibly well alongside outreach programmes,” she says. “Even some of the most deprived areas have access to mobile phones, if nothing else. Utilising digital integration, but not digital first, will enable a complete patient journey. Some will have a phone in their community, others won’t, so bricks and mortar, supported by outreach teams becomes incredibly important to provide that journey.”

Creating a care navigation system via digital integration can be a seamless option to streamline healthcare provision for all citizens. By providing it in a way that dovetails with other services, it can be integrated effortlessly into both new and existing systems.

Challenges and solutions

However, there are outlying challenges that will inevitably impact any system. In healthcare, there is a workforce shortage and an increasingly transient workforce is looking to other countries for a better work/life balance. “But if that workforce challenge can be addressed through a combination of increased remuneration and integrated, digitally enhanced services, one could use a follow the sun type model,” Jyoti considers. “A workforce based in the UK could deliver UAE services, for example, if it can be financed and become operationalised. So there is a requirement to be creative with solutions and consider other professionals in end to end care.”

Other key solutions include investing in prevention aligned to ease of access that will reap long term benefits even if they are not apparent now. In addition, she feels pharma and providers have to be better integrated with lower barriers without impacting the care/cost dynamic. Leveraging learning from the best international experience will lead to the best systems for implementation in each scenario, and will shorten the time required for this implementation.

Importantly, modelling access around patients will ensure uptake and use. “Where people use bricks and mortar, put the facility there,” she says. “If mobile works best, then use mobiles, but when you need both then implement both. Follow the patient path for success.” In this way, the concept of family medicine delivered via primary care benefits everyone, from the patient themselves, to secondary care, the provider and the payor.

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