Trends and Drivers of Change in EuropeanPrimary CareDr Rebecca RosenSenior FellowThe Nuffield Trust29th Jan 2013          ...
Primary care as first point of access to health services• First-line clinical care for undifferentiated health problems• I...
Changing scope of primary care• Traditionally including:   • assessment of undifferentiated symptoms;   • diagnosis, triag...
Multiple drivers of demand        Lack of access                 Rising patient         to social care                expe...
Wide variations in inputs across EuropeRelative provision of GPs, specialists and other doctors in Europe        No. of do...
Primary care ‘fit for the future’Attributes                            Sustainability• Comprehensive                      ...
The Primary Care Paradox....‘... a paradoxical situation: the tensionbetween the relative weakness and un-attractiveness o...
Drivers of change: political and policy trends• Significant regional variations across Europe    • Political and economic ...
Mechanisms for change: Integration and coordination• Croatia: GP led polyclinics.   • GPs employed under contract (health ...
Mechanisms for change: Privatisation, markets and newbusiness models• Large scale privatisation of  family medicine clinic...
Mechanisms for change: payment innovation• Dutch DBC payments for chronic conditions    • Integrated payments for selected...
Mechanisms for change: delivery innovationsElectronic and telephone accessto primary care• NHS Direct :   • 24 hour teleph...
Challenges for the Eurosummit• What are the essential characteristics of a primary care  system that is fit for the future...
www.nuffieldtrust.org.ukSign-up for our newsletterwww.nuffieldtrust.org.uk/newsletterFollow us on Twitter(http://twitter.c...
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Rebecca Rosen: Trends and drivers of change in primary care

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Rebecca Rosen: Trends and drivers of change in primary care

  1. 1. Trends and Drivers of Change in EuropeanPrimary CareDr Rebecca RosenSenior FellowThe Nuffield Trust29th Jan 2013 © Nuffield Trust
  2. 2. Primary care as first point of access to health services• First-line clinical care for undifferentiated health problems• Increasing focus on prevention and screening• May be founded on general practice, but is more than the work of generalist doctors, and may include other disciplines• Provided by generalist clinicians, sometimes working as part of a multi-professional team (doctors, nurses, pharmacists or other community health workers)• Is typically a level of care between self care and specialist care• May be designed around a registered population © Nuffield Trust
  3. 3. Changing scope of primary care• Traditionally including: • assessment of undifferentiated symptoms; • diagnosis, triage and onward referral; • treatment of episodic illness • provision of palliative care • prevention and health promotion .• Increasingly likely to involve: • care coordination for people with complex problems; • areas of ‘specialist’ care (eg endoscopy, minor surgery. diagnostics ) enabled by new medical technologies • new forms of access such e consultations © Nuffield Trust
  4. 4. Multiple drivers of demand Lack of access Rising patient to social care expectationsNew providers/ Primary Agingsupply induced care populations demand Rising New prevalence of medical chronic disease technologies © Nuffield Trust
  5. 5. Wide variations in inputs across EuropeRelative provision of GPs, specialists and other doctors in Europe No. of doctors per 1000 population in Europe Public expenditure on health as a % of GDP in EU member states (2008) © Nuffield Trust
  6. 6. Primary care ‘fit for the future’Attributes Sustainability• Comprehensive • Financial• Patient-centred • Workforce• Co-ordinated • Public trust• Continuous if required • Fit with wider health system• Accessible• Safe and High Quality• Population focused•Adapted from Agency for Healthcare © Nuffield TrustResearch and Quality 2013
  7. 7. The Primary Care Paradox....‘... a paradoxical situation: the tensionbetween the relative weakness and un-attractiveness of this level of care versus theintention to assign critical strategic functionsto it’From:Primary Care In The Driver’s Seat? Saltman, Rico and Boerma (eds) 2006 © Nuffield Trust
  8. 8. Drivers of change: political and policy trends• Significant regional variations across Europe • Political and economic foundations of health systems • Impact of financial crisis on health sector • Interactions between health and other sectors (eg social care)• Some overarching themes • Coordination of care • Diversification of providers/growing role for private sector and increasing use of choice and competition • Experiments with primary care purchasing and new payment mechanisms © Nuffield Trust • Care delivery innovations
  9. 9. Mechanisms for change: Integration and coordination• Croatia: GP led polyclinics. • GPs employed under contract (health insurance funds) renting space to specialists with whom they can make shared care decisions about complex patients• Germany: Disease management programmes (DMPs) • Lead doctors (usually a family physician) coordinate care related to selected chronic conditions. • Evidence based criteria for referral to specialists • Patient self-management support • Financial incentives to providers to deliver DMPs © Nuffield Trust
  10. 10. Mechanisms for change: Privatisation, markets and newbusiness models• Large scale privatisation of family medicine clinics in CEE• Pluralisation of provision and new primary care providers• Corporatisation of primary care• New ‘convenience clinics’ and walk-in centres• New business models for blending primary and specialist services (polyclinics, integrated care pathways) © Nuffield Trust
  11. 11. Mechanisms for change: payment innovation• Dutch DBC payments for chronic conditions • Integrated payments for selected chronic conditions • Payment for a year of care delivered to specified standards • Negotiated with groups of practices• Clinical commissioning in the English NHS • Compulsory GP membership of budget holding clinical commissioning croups • Influencing primary care practice and buying other services © Nuffield Trust
  12. 12. Mechanisms for change: delivery innovationsElectronic and telephone accessto primary care• NHS Direct : • 24 hour telephone advice from nurses following algorithms • NHS Direct web site - symptom checker - patient information pages - healthy living advice © Nuffield Trust
  13. 13. Challenges for the Eurosummit• What are the essential characteristics of a primary care system that is fit for the future?• Which emerging business models for primary care organisations are best supporting the development of services that are fit for the future• What is enabling primary care reform in European countries• Can we replicate and embed these factors• What does this offer to European health policy and management practice? © Nuffield Trust
  14. 14. www.nuffieldtrust.org.ukSign-up for our newsletterwww.nuffieldtrust.org.uk/newsletterFollow us on Twitter(http://twitter.com/NuffieldTrust) © Nuffield Trust

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