Public Health Intelligence Adviser Outcomes Framework for Primary Care Telling the story of Primary Care Transformation Dr Ruth Dryden Public Health Intelligence Adviser ruth.dryden@nhs.net

Talk outline A live demonstration of the Outcomes Framework Examples of how the framework is being used in practice An overview of the Primary Care Evidence Collaborative An opportunity to discuss priorities for evaluation and research in primary care

Context: Significant Reform of Primary Care

Primary Care Vision “General practice and primary care at the heart of the healthcare system. People who need care will be more informed and empowered, will access the right professional at the right time and will remain at or near home wherever possible. Multidisciplinary teams will deliver care in communities and be involved in the strategic planning of our services.” Primary care vision, setting out a strong emphasis on multidisciplinary working. Not only in the delivery of care but in the planning of services. Sits alongside the wider ambitions set out in the Health and Social Care Delivery Plan to shift the balance of care from secondary care to primary and community care, and ensuring people receive care at home or in a homely setting. Also ties with the ambitions of CMO’s Realistic Medicine that individuals are empowered and informed to make decisions about their own care.

We are more informed and empowered when using primary care NATIONAL PERFORMANCE FRAMEWORK OUTCOME We start well We live well We age well We die well Our vision is of general practice and primary care at the heart of the healthcare system. People who need care will be more informed and empowered, will access the right professional at the right time and will remain at or near home wherever possible. Multidisciplinary teams will deliver care in communities and be involved in the strategic planning of our services. PRIMARY CARE VISION HSCP OUTCOMES People can look after own health Live at home or homely setting Positive Experience of Services Services improve quality of life Services mitigate inequalities Carers supported to improve health People using services safe from harm Engaged Workforce Improving Care Efficient Resource Use We are more informed and empowered when using primary care Our primary care workforce is expanded, more integrated and better co-ordinated with community and secondary care Our primary care services better contribute to improving population health Our experience as patients in primary care is enhanced Our primary care infrastructure – physical and digital – is improved Primary care better addresses health inequalities PRIMARY CARE OUTCOMES

Primary Care Outcomes Framework The Framework maps out the changes that need to happen to deliver our Vision for Primary Care over the next 10 years. Developed through an extensive process of engagement and mapping of related activity across Scottish Government and wider stakeholders. Overarching strategic model; 3 nested logic models (covering ‘people’, ‘workforce’ and ‘the system’). Tool provides a mechanism for undertaking analysis and review (including self-evaluation), for planning, for articulating theories of change and understanding contributions to outcomes and attribution, and for communicating evidence. http://www.gov.scot/Resource/0053/00534658.pdf

Primary Care Indicator Set High level indicator set developed to help monitor progress across the primary care strategic level outcomes. Not exhaustive! A relatively small number of “big dot” measures which track system level change within primary care Longer term ambition to broaden the scope of the indicators as the underlying data availability improves Recognition that information requirements will vary across different organisations / stakeholders

Uses of the Outcomes Framework Scottish Government’s Monitoring and Evaluation Strategy Implementation of the Primary Care Workforce Plan Evaluation of Primary Care Digital Services Development of the General Practice Nurse role Neighbourhood Care Hospital to Home pilot in the Borders Royal College of General Practitioners’ Interface Groups project

Primary Care Evidence Collaborative Members

Primary Care Outcomes Framework Research Evaluation Improvement Voice of lived experience Workforce Data

Early Scottish Government Evaluation Priorities Synthesising and sharing learning from good quality evaluations by others of new models of care, service redesign, and other innovations where these show promise for scaling-up, sustainability and impact. Policy initiatives / investment intended to reshape and increase the effectiveness of primary care, including implementation of the 2018 GMS contract and MoU. Developing the evidence for, and applying, the national-level indicator set, developing an online data resource and establishing reporting arrangements. Understanding public and workforce views and experiences of primary care reform, including workforce wellbeing.

Review of Primary Care Improvement Plans “all PCIPs should include consideration of how the changes will be evaluated locally” Variation in the: Detail provided on local evaluation plans Use of the word ‘evaluation’ Extent to which plans were evidence-informed Use of data including population health needs assessments Involvement of analysts (LIST/ local Public Health teams) Appropriate use of methods and findings Expectations of evaluation to inform delivery in years 2 and 3

Outcomes Framework (in development) Click on excel file to access draft outcomes framework which includes list of strategies and evaluations that were discussed at the LIST event on 19th Sept

Other resources (right click to open hyperlinks) ISD (2018) A Guide to Data to Support Health & Social Care Partnerships in Joint Strategic Commissioning and Joint Strategic Needs Assessment ISD (2014) Population Needs Assessment for Health and Social Care Partnerships: guidance on the use of data sources Improving Together Interactive

Group discussion

What are your priorities for research and evaluation? 1. What are your priorities for research and evaluation?

[How] could the Outcomes Framework help your work? 2. [How] could the Outcomes Framework help your work?

What should be done once for Scotland? 3. What should be done once for Scotland? e.g. Theories of change, evidence reviews, methods, data sources, findings – what works/ doesn’t work for whom in what circumstances and why? How – networks/ collaboratives, portal/ website, toolkits/ resources, nationally agreed outcomes and indicators