The second Future Forum exercise has focused new attention on care coordination, as the practical expression of ‘integrated care'.
National Voices submitted a paper to the Forum on ‘What patients want from integration'. We said integrated care programmes that don't specify how care is to be coordinated will fail. To quote from our paper: ‘Patients expect professionals to work together as a ‘team around the patient', and they want services to work together likewise: that is, to come together at the point they are needed, and to meet people's needs in the round.'
Likewise, in their advice to government, the Nuffield Trust and King's Fund said all patients with complex needs should be guaranteed a care plan and ‘a named case manager responsible for co-ordinating care'.
CCGs considering how to integrate care will need to design service packages that make clear to both staff and patients who, at any time, is responsible for coordinating individuals' care, and ensure these professionals have funds and clout to deliver.
RCGP president Clare Gerada told party conference fringe meetings with National Voices last year that GPs are the patient champion responsible for coordinating care.
Patient organisations welcomed her words and the intentions behind them, but doubted that GPs know enough about specific conditions to play this role themselves. Patients often cite patient-focused specialists such as clinical specialist nurses, practice nurses with special interests, or advisers funded by relevant charities.
National Voices argues that the GP, as holder of the registered patient list and gatekeeper to services, begins as the ‘default' coordinator. But they should sit in a hub of services, working in multidisciplinary teams across boundaries, and being prepared to ‘hand off' or delegate care coordination to others.
This may require a little more capacity both to coordinate and to manage interfaces; but also and more importantly requires a change of practice towards active case management for targeted groups of patients. The ‘year of care' approach, now proven in diabetes, has been adopted as the RCGP's recommended approach to long term conditions management; and a tariff will be developed for it.
To put this into practice we need a vision of ‘interlocking' rather than organisationally integrated services. As the King's Fund primary care inquiry concluded: ‘General practice needs to see itself at the hub of a wider system of care, and must take responsibility for co-ordination and signposting.'
GPs as commissioners would need to increase the value derived from health and social care spend by knitting services closer together, investing more in primary and community care and less in hospitals.
They should work with councils through health and wellbeing boards to ensure the most imaginative and efficient use of the whole health and social care funding pot for people with complex needs.
To ensure the patient's perspective becomes the organising principle, commissioners would need to make full use of voluntary and community sector contributions – not only as providers but as consultants, co-designers and monitors of the quality of coordinated care.
Don Redding is policy director for National Voices
Read more on integration and what patients are calling for on National Voices' website.
