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Why integration is such a good thing

Dr Mike Dixon on the important role PBC has in bringing the different NHS players together to improve the patient journey

Dr Mike Dixon on the important role PBC has in bringing the different NHS players together to improve the patient journey

Integration has to be ‘a good thing'. What patient would ask for their care to be provided in as many different locations as possible, by as many different people as possible and for it to be as disjointed as it can be?

Yet sometimes the NHS seems to offer exactly that. Secondary and primary care are divided by a Berlin Wall consisting of organisation boundaries and Payment by Results. Health and social care appear to belong to two different planets and patients are left to negotiate a system based upon historical (and not entirely logical) professional and organisational tribalism.

There is a better way. The articles in this section are an illustration of just that. PBC offers the ideal opportunity for clinicians at the front line to design services that are properly integrated and offer the patient something different and better.

At the end of the track are integrated care organisations. Proposed in the NHS Alliance's March document In Sickness and In Health and ratified in Lord Darzi's Primary Care Strategy in July, they are to be piloted from this autumn. Indeed, the prospectus has been published and applications are invited. They will be the advance guard of integration, based on the registered list and most, hopefully, will be primary care- and clinician-led.

Important as they are, only a small proportion of this country's patients will be cared for by the integrated care pilots. For the vast majority, the priority over the next few years will be simply how we can integrate things a little bit better. Our aim should be to integrate services rather than rush to become fully integrated organisations as, frankly, it is the services that matter to our patients.

PBC consortiuns will be the prime movers of such integration and the focus will be on them and their PCTs to ensure that service redesign proceeds as rapidly as possible so that integration can become reality.

In particular, that will require quick footedness by both commissioners and PCTs without too much agonising over the mixing of provider and commissioner roles. After all, integrated care organisations are a hybrid of both – the ICO providing what it can and commissioning the rest. The patient is not concerned about these fine commissioner-provider lines. They simply want a co-ordinated service.

Consequently, important as ICO pilots may be, the biggest noticeable service change overall will come from ordinary practice-based commissioners beginning to offer more integrated approaches in services and health. Hopefully (and many of us are currently working hard behind the scenes on this) they will be able to access SHA-based innovation funds to support their work. Hopefully, each PBC group will be fully supported by its PCT and SHA and be allowed a relatively free hand to innovate.

There are some who will argue, with good reason, that integrated care could threaten patient choice and market competition. The truth, though, is that patients want an effective, co-ordinated and integrated local service first and foremost. Nevertheless, commissioners will need to be sharp-edged when a service is insufficiently good or cost-effective.

At a time of economic recession, when the NHS will increasingly focus on cost-effectiveness, the move toward integrated services and organisations may herald a new balance in Britain between competition and the ability of local services to provide comprehensive, co-ordinated and cost-effective healthcare.

So, for practice-based commissioners, the direction of travel is clear. We will need to work increasingly with local authorities, secondary care and all relevant local health services, health initiatives and the third sector. If practice-based commissioners with an increasing role in provision do not grasp these opportunities, then foundation trusts and corporate enterprise undoubtedly will.

The process can be organic, it does not need to be at breakneck speed and the focus must always be on integrating services with organisational development following rather than vice versa. Every practice-based commissioner should be thinking on these lines now.

The case studies that follow point the way forward.

Dr Mike Dixon is chair of the NHS Alliance

Focus on...integrated care - why is it such a good thing?

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