Primary care: national monitoring and evaluation strategy

The Primary Care Outcomes Framework

The Primary Care Outcomes Framework was developed through an extensive process of engagement and mapping of related activity, firstly across Scottish Government health and social care policy areas (recognising that primary care is part of a wider, increasingly integrated health and care system) and then with a wider set of stakeholders through meetings and events.^[24] The Framework (Annex 1)^[25] provides a shared structure (in the form of a logic model) to articulate how we expect to realise the Primary Care Vision and is an important conceptual and practical evaluation tool. 

The Framework can be adapted for different levels or scales within the system and will evolve over time. It consists of an overarching, strategic level logic model with three nested logic models which set out how outcomes will be achieved and what continuous improvement should look like for: people, the workforce, and the wider health and social care system. The Framework is, therefore, an important evaluation tool. 

The Framework provides a flexible organisational mechanism for planning and undertaking analysis and review (including self-evaluation), for planning, for articulating theories of change, for understanding contributions to outcomes and attribution, and for communicating evidence. It can be used to:

• Map and analyse whether and how actions are contributing to intended changes 
• Identify and address primary care evidence gaps and appropriate ways to address these 
• Improve the availability, quality and comparability of primary care data and evidence by identifying and recommending appropriate methods, data sources and indicators to capture local and national learning
• Identify and prioritise common research and evaluation questions
• Inform decisions about what to evaluate and how
• Represent and refine theories of change underpinning the Outcomes, policies and services
• Coordinate and share learning from local changes and pilots to inform scale-up and roll-out of the most effective interventions in particular contexts.

Research and evaluation undertaken or commissioned on behalf of the Scottish Government (at the macro or meso levels) will complement and, at times, include other fields of activity concerned with evidence, understanding and learning. This may comprise, for example, improvement methods, organisational change management, “middle ground research”^[26] (in a space between policy, practice and science), and traditional clinical research. The Framework therefore offers bodies, with responsibilities for planning, delivering and reporting on primary care, a tool for planning evaluation and research activity, locating evidence and analysis within a wider evidence framework, and encouraging reflection on activity and assumptions.