Radical Alaskan health plan piloted to save Scots NHS
BY JUDITH DUFFY
SCOTLAND is testing out a pioneering system of healthcare developed in the remote American state of Alaska. The Nuka model of care is run for Alaskan native and American Indian people by a state-funded health system. Trials are now taking place, backed by the Scottish Government, as part of a major drive towards the integration of health and social care services.
The Nuka model involves dedicated teams of GPs, nurses and other health professionals such as psychologists and dieticians providing care for a small list of patients. There is also an emphasis on education and training in the community, and traditional Alaska Native healing is offered alongside health and social care services.
The system, which was developed in the 1990s, has resulted in a 36 per cent reduction in days spent in hospitals and the slashing of emergency cases by 42 per cent, according to report by health think tank The King’s Fund. The Southcentral Foundation, which runs the Nuka model, is also said to have transformed healthcare for Alaskan native people from “among the worst in the United States to among the best in the world” over three decades. The pilot tests in Scotland range from setting up small teams of mixed health professionals in GP practices to “social prescribing” initiatives offering health-related activities such as dance classes and cookery clubs.
Maxine Jones, primary care development adviser with Scottish-based think tank International Futures Forum, who visited Alaska in 2012 to see the Nuka model in action, said she believed it could work for Scotland. “The focus [for Nuka] has been very much on putting the patient first and developing the service according to what the patient thinks, as opposed to what the health professionals think,” she said.
“They have a tagline: it is all about relation- ships – so everything that happens is geared towards optimising relationships, both between the patient and care providers and also among the care providers themselves.”
Jones said the Nuka model was based on a comprehensive team, including a GP, nurse, healthcare assistant and administrator, looking after a list of 1,400 patients. She said this was a relatively small number compared to the current GP practice size in Scotland of around 1,800 and upwards per each full-time doctor. “Because the teams are dealing with relatively few patients, they are able to give patients the time they need, so they are able to do things like care and support planning and helping people with wellness as well as illness issues,” she said.
Jones said the model could work for Scotland and was already being tested out, but cautioned it would take some time to evolve. She added: “I believe it could provide the solution to the crisis in primary care currently. However, there are significant barriers to overcome – for example, it is very hard for practices to be able to only see 1,400 patients per whole-time equivalent GP. That is unheard of amidst a GP recruitment crisis. One of the beauties of Nuka is it has a whole range of extended services available where people can be sent immediately, whereas most practices here maybe have a physiotherapist, for example, that comes in once a week. It would need to be a lot more comprehensive.”
Andrew Strong, assistant director of policy and communications at the Health and Social Care Alliance Scotland, said the Nuka model should be tested out as part of the integration of health and social care services.
Shona Robison, above, Scottish Health Secretary, said: “The roots of their system are integrated healthcare social care and mental health, with a very strong emphasis on patient and family involvement in care decisions. Presently we are testing various elements of this in Scotland.”