ChallengeWest Wakefield Health and Wellbeing Board needed to pilot the Multi-speciality Community Provider (MCP) model in GP practices in the area to test and deliver different models of care.
NHS England provided funding for evaluation of all New Care Models (NCMs) in 2016/17.
West Wakefield Health and Wellbeing Board piloted the Multi-speciality Community Provider (MCP) model in GP practices in the area to test and deliver different models of care.
The models included development of services such as:
- Care Navigation: helping local people to access the care they need more quickly
- Physio First: allowing patients to get a direct appointment for an initial assessment with a Physiotherapist without having to see the GP first.
- Pharmacists in General Practice: to deliver medicine-related services.
- Extended Operating Hours for GP services.
Building on original work by the NECS consultancy team, the Research and Evidence team were appointed to undertake a multi-method evaluation. West Wakefield had commissioned Healthwatch Wakefield to evaluate patient experience of the new services. The NECS team had oversight of this work to ensure it was aligned and complemented the evaluation. In line with NECS’ project-managed approach, an overarching project management support was applied to ensure the evaluation met the objectives, resource requirements and time constraints of the customer.
To evaluate the successes and challenges of Vanguard services a number of approaches were taken.
- Qualitative Evaluation aimed to:
- Explore the changes Vanguard services have made to the work life in individual practices;
- Map which components of the new care model were perceived to make a difference, why, how and to whom;
- Explore unintended costs and consequences associated with the new care model;
- Measure the impact the Vanguard model has had on patient experience within primary care (undertaken by Healthwatch Wakefield)
In-depth, semi-structured interviews were conducted with 23 individuals across 9 primary care practices. 720 patient surveys were collected during the course of visits to GP practices by Healthwatch Wakefield. Both staff and patient experiences were explored.
Health Economic Evaluation was undertaken on the costs and outcomes (real and virtual) of the HealthPod and to inform the sustainability of the programme. The HealthPod was a ‘pop-up’ primary care facility offering health checks, wellbeing advice and assessments in neighbourhood locations. A cost-consequence analysis was used to identify the associated costs and outcomes of the HealthPod.
Quantitative Evaluation. NECS had previously worked with WWHW in developing metrics and dashboards for the NCM vanguard and for reporting to NHS England. Information was collated providing a comprehensive picture with regard to lengths of stay, admissions and A&E attendances, Walk in Centre attendance rates and referral counts. In addition the number of care navigations, physio and pharmacy time used were collected.
Healthwatch Wakefield worked alongside NECS to deliver the evaluation of the West Wakefield Multi-speciality Community Provider Vanguard in 2016/17. We enjoyed working with NECS colleagues, and found them professional, collaborative and knowledgeable. We learned a lot during the joint evaluation and would be very happy to work with them again
Combined planning, analysis and reporting, from the qualitative researcher and Healthwatch Wakefield, allowed a richer and more robust evaluation.
Introducing change takes time. All parties need to be on board at the beginning of the process, be consulted as appropriate and need to feel involved throughout.
Feedback on a number of the interventions has been positive from patients, though there have been some mixed views from the staff involved, although staff were in a variety of states of engagement with the Vanguard programme at the time of the evaluation.
Many strands of the Vanguard were well received and starting to work in the practices.
It is important to have a process in place to baseline the starting point and measure change when targeting a specific intervention e.g. difficult to quantify the benefits of the HealthPod to the original target patient population.
It needs to be recognised that change takes time to embed and some may be aspirational and impacted by delays elsewhere in the system and needs to be considered in the round. There are lessons to be learnt from the evaluation itself and available data may drive what can actually be evaluated. Measuring implementation and performance needs to be considered at the design stage.
This external independent evaluation has allowed WWHW and WW CCG to get a deeper and richer understanding of the implementation of the Vanguard from the extensive qualitative research that added value to the metrics data already available.
The final report which can be found below was circulated to West Wakefield Health and Wellbeing Limited and West Wakefield CCG.