Two local vanguard leaders explain what it means to be an integrated primary and acute care system (PACS)

The national new care models programme brings together local health and care systems as vanguards to radically redesign care for the local populations they serve.

As part of this work, NHS England has set out details of a new framework – integrated primary and acute care systems – Describing the care model and business model – Paul Mears, Chief Executive, Yeovil Hospital and local GP, Dr Berge Balian – both members of South Somerset Symphony Programme vanguard (@Symphonyproj) – take a look at what the proposals could mean.

Paul Mears, Chief Executive, Yeovil Hospital – @Pauldmears

As an integrated primary and acute care system (PACS) vanguard, we’re leading one of the most exciting revolutions in NHS system development: remapping commissioning and provider structures in a way which makes them truly clinically-led and future-proof.

Dismantling organisational boundaries, particularly those between acute and primary care, has led to a shared understanding of clinical and business challenges and enabled us to develop new models of care which accurately reflect current and projected demand.

Our first complex care hub (hospital based and GP led) has eroded the primacy/acute divide, and the movement of more practices to the enhanced primary care (EPC) model (building capacity and capability with new roles and a multi-disciplinary approach) is helping to give GPs the necessary breathing room to care for their most complex patients.

The PACS framework reinforces the General Practice Forward View imperative of embedding GPs as leaders within integrated organisations, and our Symphony vanguard programme board – a combined strategic leadership team of GPs, practice managers, hospital consultants and executives – continues to develop the infrastructure required to create such a joint venture within Somerset.

We now have a robust platform from which to address and capitalise upon the contractual challenges and opportunities posed by outcome and population based budgets, and from which to launch our accountable care system.

Our role as a vanguard is to identify the barriers which stand between today’s NHS and the more sustainable NHS of the future, and to test the solutions which will overcome them. The framework further clarifies the importance of this work, inspires others and gives all PACS vanguards additional momentum to achieve success.

Dr Berge Balian, GP

The launch of the integrated primary and acute care system (PACS) framework is a significant positive step to recognising the opportunities created by both clinical and organisational collaboration between primary and secondary care, and reinforces the work already taking place in south Somerset.

Crucially, we have been able to demonstrate that it is possible to create a PACS framework that allows primary and secondary care to integrate, whilst protecting general medical services and personal medical services contracts and allowing reversibility of those contracts under specific circumstances.

In common with much of general practice across the country, GP practices in south Somerset are under pressure to cope with the combined challenges of increasing patient need and the complexity of supporting an ageing population. We have also seen a shift of care from other sectors to primary care without the mechanism in place to allow an equivalent shift of resources.

Hospitals are coping with the same demands and are under the same increasing pressures. The Symphony Programme vanguard has created an opportunity to bring together all healthcare partners (and indeed social care and the third sector) to begin the redesign of care services to ensure that they are focussed on patient needs (right care, right place, right time) without the existing contractual constraints.

We consider the PACS model to be similar in principle to the multispecialty community provider (MCP) model, but with inclusion of acute hospital services. The advantage of this is that the ‘most expensive’ part of the healthcare sector is included in the design and implementation of new models of care, with aligned incentives that support a collaborative approach. This is allowing us to shift resources into primary care and community services, enabling cost effective care to be delivered closer to the patient –whilst ensuring that primary care thrives and secondary care provides only those elements of care that it is essential to provide in that setting.

I am proud that through close partnership working, my colleagues and I are not only helping to redesign the way that core primary care services are delivered, but also expanding the scope and quality of services delivered in the community.  These will in turn, ensure that essential secondary care services can be delivered in a timely and cost effective way.

The PACS framework will provide a recognised structure for us to maintain momentum and continue to build on the important progress already made within south Somerset. It will continue to help us break down traditional barriers between care providers and move towards the radical whole system approach to integrated care that will enable us to provide an efficient and sustainable healthcare service for our communities, now and into the future.

Paul Mears

Paul Mears joined Yeovil District Hospital NHS Foundation Trust as Chief Executive in May 2012. Paul was previously Chief Operating Officer at South Devon Healthcare NHS Foundation Trust where he was responsible for leading operational services in Torbay Hospital. He also has considerable experience of working in community services having been Director of Operations at Torbay Care Trust where he was responsible for integrating community health and social care services in one of the leading examples of integrated care in the UK.

Dr Berge Balian

Dr Berge Balian has been a full time GP in a large semi-rural practice in Somerset with approximately 11,000 patients for the past 20 years, having completed his medical training at St Thomas’s Hospital in London.

Berge has a career long interest in medical politics and has been a representative of the South Somerset GP practices on the Somerset Local Medical Committee (LMC) for the whole of his GP career – including a period as Chair of the LMC. He has been Associate Medical Director for Primary Care at Yeovil District Hospital NHS Foundation Trust since 2013 and was elected to the role of Chair of the Symphony Programme Board in April 2015.