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Total purchasing, community and continuing care: lessons for future policy developments in the NHS.
Sally Wyke1, Susan Myles, Jennie Popay
1On behalf of the Total Purchasing National Evaluation Team (TP-NET),University of Edinburgh, Primary Care Research Group, UK,University of Salford, Public Health Research and Resource Centre and National Primary Care Research and Development Centre, UK,Sefton Health Authority, Director of Community Care, UK,University of Manchester, Health Service Management Unit and National Primary Care Research and Development Centre, Manchester, UK.
Total purchasing pilots (TPPs) in the National Health Service (NHS) offered opportunities for general practitioners (GPs) to develop community and continuing care (CCC) services. However, TPPs showed limited policy awareness and needs assessment, highlighting a need for guidance to improve integrated care delivery.
Area of Science:
- Health Services Research
- Public Health Policy
- Primary Care Management
Background:
- Total Purchasing Pilots (TPPs) in the National Health Service (NHS) aimed to empower General Practitioners (GPs) in developing community and continuing care (CCC) services.
- This study examines the extent to which TPPs integrated CCC policy, conducted needs assessments, and involved stakeholders in service development.
Purpose of the Study:
- To evaluate the awareness of CCC policy among TPPs.
- To assess the use of joint commissioning and population-based needs assessment in TPPs.
- To determine the extent to which TPPs involved users, carers, and voluntary agencies in their planning.
Main Methods:
- Qualitative analysis of five case studies involving TPPs engaged in CCC development.
- Examination of TPPs' approaches to policy awareness, joint commissioning, needs assessment, and stakeholder involvement.
Main Results:
- TPPs demonstrated limited awareness of national and local CCC policies, despite some initiatives addressing policy issues like inter-practice collaboration.
- Four TPPs explored integrated purchasing, with three developing sophisticated models for integrated care provision.
- Service development was not consistently informed by systematic, population-based needs assessment.
Conclusions:
- Primary care-led groups have potential to enhance horizontal and vertical integration of care.
- Policy guidance and support are necessary to prioritize CCC, promote population-based needs assessment, and foster stakeholder engagement.
- Incentives, such as budget control, may be required to encourage inter-agency collaboration.