CardiovascularBreaking The Boundaries Between Primary And Secondary Care, UK
The second wave of Integrated Care Pilots should be developed among existing promising commissioners and providers to encourage a complete restructuring of the way primary and secondary work together.
The current pilots, which were suggested by the NHS Alliance at the beginning of last year*, have not been able to comprehensively redefine the boundaries between primary and secondary care in a way that allows for a significant redesign of out-of-hospital services. This is not to say that many of the pilots are not breaking new ground in developing integrated services in particular disease areas, bringing together Primary Care Trust providers, GPs, social services and third sector services.
Dr Michael Dixon, chairman, NHS Alliance, said: "Integrated Care Pilots are an excellent idea, but instead of choosing from a list of applicants, we should work closely with a few committed commissioners and providers to help them further develop services that really break the boundaries between primary and secondary care by creating a truly integrated provision."
The NHS Alliance is also calling for some of the second wave pilots to be based within practice-based commissioning consortia. This will enable them to develop services in partnership with secondary care clinicians, where any overarching structure might be not-for-profit and run by the community and its primary and secondary care clinicians and managers.
Dr Dixon added: "Only then we can test the concept of a geographically- based health maintenance organisation whose arrangements for integrated services and initiatives are actually provided by a local group, who is also responsible for commissioning."
The NHS Alliance believes that such an organisation would work closely with social services, third sector, private sector and other agencies, but its initial focus should be on fully integrated primary and secondary care with a view to realise the potential of out-of-hospital care.
An independent steering group of experts, including academics, managers and clinicians, appointed by the Department of Health, should also be set up to choose the relevant candidates and help them develop and implement their projects.
Notes
1. The Integrated Care Pilots were suggested by the NHS Alliance in its report In sickness and in health: achieving an integrated NHS, published in April 2008. For a copy of the report, please contact pressoffice@nhsalliance.org
2. On 2 July the Department of Health announced the start of the 16 Integrated Care Pilots (ICP). The pilots will run for two years and will be evaluated over three years against a set of national and local measures. Six sites have been selected for deeper evaluation by independent external evaluators, Ernst and Young and Rand Europe. The pilots vary from developing new models of long-term condition management to help patients choose their end of life care, to enabling people to self-manage COPD care. Pilot sites are working across primary, secondary, community and social care services, public and third sector organisations to forge new partnerships, systems and care pathways. An interim report is expected to be issued in early 2010. For further information, visit www.dh.gov.uk/integratedcare
3. The NHS Alliance is the only independent body that brings together primary care trusts" chief executives and other senior managers, doctors and practice managers, nurses, pharmacists and allied health professionals, along with board chairs and members. We are a value-driven organisation, with no political affiliation, which works in partnership with various bodies associated with the NHS to create a progressive health service that is free from the traditional tribalism of single interest groups.
NHS Alliance