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Primary Care at Scale

Project Lead: Charlotte Refsum

Project Manager: Pam Crye


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 is progressing:

  • Building out the strategy in more detail with key stakeholders
  • Ongoing co-design and development of the high level target operating model for all providers (GPs, Pharmacists, Opticians and Dentists)
  • Developing approaches for key requirements for Primary Care to deliver at Scale (Leadership development; Population Health Management/Risk stratification)
  • Supporting mobilisation of prototypes (iterative implementations e.g. First Contact Practitioners)

Aims for the next 12 months

  • Development and approval of an outline business case for the target operating model
  • Completion of co-design of the detailed target operating model
  • Development and approval of the detailed target operating model and implementation plan

Public Engagement

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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