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New GP contract needed for integrated care to take off

Significant reform is needed to the GP contract if integrated care organisations (ICOs) are to become an effective force within the NHS, according to a leading academic.

Dr Richard Lewis, senior associate at the King's Fund and co-author of a new report on integrated care, told a recent London conference: ‘You can't keep the GP contract out of it. It's fundamentally at the centre of it.'

The report, Where next for integrated care organisations in the English NHS?, jointly produced by the Nuffield Trust and the King's Fund, says that if ICOs are to succeed as a model where others have failed, ‘significant reform to the GP contract may be needed to either embed new incentives for integrated care, or more controversially, give PCTs greater discretion over the retention of GP contracts.'

At the conference, Dr Lewis went on to tackle the conflict-of-interest issue that has dogged practice-based commissioning.

He said the argument for a split between the commissioner and provider roles was to avoid some ‘unholy alliance' between the two.
‘I have very little sympathy with that argument,' he said. ‘Having some sort of merger between commissioner and provider roles is not the problem – the whole point of primary care commissioning is that you want to make use of that unique position that primary care teams have.

'They can take an overview of the system and can decide whether to refer or to treat and we want them to be thinking about whether they make or buy.'

At the conference, held at the King's Fund offices in central London, Dr Jennifer Dixon, director of the Nuffield Trust who co-authored the report, said there was still an ‘enormous divide' between primary and secondary care.

‘The biggest opportunities are in health and social care,' she said. ‘But I feel that our own backyard in (integrated) healthcare isn't really sorted.'

The report is available from the Nuffield Trust website.