Primary Care at Scale

This project is responsible for the delivery of Recommendation 15 of the Final Report following Sir Jonathan Michael’s Independent Review of the Isle of Man Health and Care system

Recommendation 15 states that:

'the Isle of Man should establish a model for delivering Primary Care at scale, since further and deeper collaboration within Primary Care is necessary to deliver current services and provide additional local services.' 

The project will also need to consider Recommendation 12, which states that:

'Service by service integrated care pathways should be designed, agreed and delivered. These should encompass both on and off-Island components of clinical service models.' (Working with Care Pathways and stakeholders to develop new ways of working and care pathways.)

Primary Care at Scale is a multidisciplinary team based approach to support patient centred initial health and care interventions based on the needs of the person, providing a holistic primary care for the whole population. The multidisciplinary team will include a broad set of professionals, such as GPs, first contact practitioners (e.g. specialist physiotherapists, associated physicians, and community prescribers).  

The At Scale model will create an integrated model across all elements of Primary Care, maximising benefits through operating at scale while also ensuring a personalised patient-centric care model.  Working with existing programmes and building on work already done e.g. Wellbeing Partnerships.

At Scale GP services will be delivered through a Primary Care Network. This will build upon the Isle of Man Primary Care Network (IOMPCN), which has been established to work collaboratively to enhance the level of services provided in Primary Care. Commissioning of dentistry, optometry and community pharmacy will also encourage partnership working.

The main objective of this project is:

• To provide equity of access and services across the Island for patients by GPs, community pharmacy, optometrists and dentists through new and enhanced models of service. Main elements to this are:
  
  
  • Supporting the delivery of a more personalised Model of Care that has the patient at the centre (how patients will be supported differently in Primary Care)
    
    
  • Co-design and implementing the optimal strategy and Operating Model to deliver Primary Care services collaboratively and at scale on the Island (how the system will operate differently within and between Manx Care and Primary Care organisations)

Right care, in the right place, at the right time, in the most affordable way.

A baseline strategy has been developed, building on UK and global evidence and initial co-design. The baseline strategy was agreed by Manx Care in May 2021.

The project has completed:

• Building out the strategy in more detail with key stakeholders.  This included an approach to several key requirements including leadership development and population health management. Detailed strategy received Board approval March 2022
  
  
• Ongoing co-design and development of the high level target operating model (HLTOM) for all providers (GPs, Pharmacists, Opticians and Dentists). The HLTOM was approved by the Board in May 2022
  
  
• Planning and scoping and commissioning of detailed design approach and development of strategic business case.  (October 2022 – pending approval)
  
  
• Supporting mobilisation of prototypes (iterative implementations e.g. First Contact Practitioners)
  
  
• The project was paused between October 2022 and October 2023, to allow resources to be focussed on Manx Care achieving financial balance in 22/23 and to allow time for the recurrent funding issues to be addressed. Some background work has continued in the interim period

The Manx Care Board, whilst absolutely committed to PCAS as outlined in the strategic business case  are not able to commit to the full strategic business case outturn at this time, due to the current financial position.  Instead, Manx Care wish to take a more incremental approach, so that each of the initiatives described is planned in detail, costed fully, the benefits and (where appropriate) savings, calculated and agreed.

23/4 will therefore be focused on stabilisation and adaptation of the strategic implementation plan, taking a test and learn approach. This will include a number of key activities:

• Implementation and rollout of First Contact Practitioner prototypes
  
  
• Design, development and rollout of Primary Care (locality) Hub pilots (regional integrated primary and community care)
  
  
• Completion of co-design of the detailed target operating model for Year 1 of strategic implementation
  
  
• Development of a full business case to support Year 1 implementation of at scale primary care

A key outcome for the project will be to support the delivery of personalised care closer to home. This aligns with the Transformation Programme’s aim to support delivery of the right care, in the right place, at the right time, in the most affordable way.

With the above in mind, the public were invited to share their views on how these services can best support you to be happy and well.

After hearing the views from the public, we asked staff to share their views to help us understand how Primary Care services (General Practice, Pharmacy, Optometry and Dentistry) can work together more effectively to improve not only a better experience for our colleagues, but deliver a better patient experience and outcomes. 

We want to understand which changes would be most important to health and care professionals, and what you think would bring the most positive benefits and outcomes for Manx residents. You have a pivotal role in delivering health and care services on the Island so we want your input to shape their future!

The results are now available and will be used to develop a more detailed Model of Care.

Thank you all for taking part!

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