Evaluating primary care transformation: Synthesis of findings from UK pilot project reviews

Background Pilot “new models” of primary care have been funded across the UK since 2015, through various national transformation funds. Reflections and syntheses of evaluation findings provide an additional layer of insight into “what works” in transforming primary care.

Aim To identify good practice in policy design, implementation and evaluation for primary care transformation.

Design & setting A thematic analysis of existing pilot evaluations in England, Wales and Scotland.

Method Ten papers presenting evaluations of three national pilot studies – the Vanguard programme in England, the Pacesetter programme in Wales and the National Evaluation of New Models of Primary Care in Scotland, UK – were thematically analysed, and findings synthesised in order to identify lessons learned and good practice.

Results Common themes emerged across studies in all three countries at project and policy level which can support or inhibit new models of care. At project level, these include: working with all stakeholders, including communities and front-line staff; providing the time, space and support necessary for the project to succeed; agreeing on clear objectives from the outset; support for data collection, evaluation and shared learning. At policy level, more fundamental challenges relate to the parameters for pilot projects – in particular, the typically short-term nature of funding, with an expectation of results within 2-3 years. Changing expectations about outcome measures or project guidance, part-way through project implementation, was also identified as a key challenge.

Conclusion Primary care transformation requires co-production and a rich, contextual understanding of local needs and complexities. However, a mismatch between policy objectives (care redesign to better meet patient needs) and policy parameters (short timeframes) is often a significant challenge to success.