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At the heart of general practice since 1960

Focus on…bridging the primary-secondary divide

Jo Webber sets the scene for GP commissioners as they aim to integrate the traditionally separate areas of primary and secondary care

http://www.pulsetoday.co.uk/practical-commissioningl

Integrating care is all about improving services for patients and making them the best they can be. The Government's proposed reforms for the NHS offer a chance to make this happen, building upon much of the already good work that is taking place.

Clinicians will be given greater commissioning powers and more control over how local care is planned and provided, and the regulator Monitor will have a role to focus on improving care for patients and to promote integrated care as well as competition. This presents a real opportunity to look at how we can drive up the quality of care by joining up services.

Integrated care has historically been hampered by a perceived divide between primary and secondary care providers and between the NHS and local authorities.

This division has often existed because of a lack of join-up between commissioners and providers, rather than as a result of how patients use services.

There is strong evidence that integrated care can be the most effective way of delivering healthcare, particularly for patients with long-term conditions.

We see how the north-west London integrated care pilot is not only aiming to considerably reduce hospital and nursing home admissions and provide more tailored care for elderly patients and those with diabetes, but is also on course to drive significant savings.

The Government's aim of creating a patient-led NHS has increased interest in integration and, encouragingly, many local organisations have plans under way to join up primary and secondary care services.

However, there are a number of things that commissioners and providers need to get to grips with before setting off on a course of locally led integrated care.

The most common risk of failing to join up care effectively usually concerns an over-estimation of how quickly change can be delivered, and an under-estimation of the importance and difficulty of the cultural issues to be tackled.

Developing the right culture and relationships is crucial, and it is essential that all parties share the same aims and objectives from the outset.

Without proper communication between organisations and individuals, there is a real risk that enthusiasm and momentum will be lost, and patients will end up with a service that is of worse quality than it was before the integrated care project was initiated.

Another issue to tackle is getting the right data and information systems in order. Data is not only crucial for monitoring the success of a project, but it is also central for sharing information about the patient across systems.

Integration is an issue that needs to remain high on the agenda as both health and social care face the impact of an ageing population and a rise in long-term conditions.

We must ensure that we are delivering care in the most appropriate surroundings for patients, with the right mix of staff and services, while getting the best bang for our buck as resources tighten.

Jo Webber is deputy director of policy at the NHS Confederation

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