Integrated care. Joined up care. Coordinated care. Call it what you will but most people - patients, health professionals and politicians - agree we need it. National Voices, the national coalition of health and social care charities in England, have defined integrated care from the patient’s perspective: My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes. This is clearly what the NHS should be doing, but we seem to fail abjectly time and again in delivering it.
My belief is that building a robust, joined-up primary and community based health and social care system is one essential building block for delivering the type of care that our patients want. As CCGs this gives us a problem. We are responsible for commissioning nearly all community based health care apart from in-hours general practice. Responsibility for the latter lies with NHS England, and in Cumbria’s case the small team with this responsibility lives at the opposite side of the country in Newcastle.
If we want to develop new integrated approaches which bring general practice together with community based health services, social care and non-traditional providers, to provide 24/7 out of hospital care, will the national GMS contract give practices the flexibility to really join things up? I think this is unlikely without some fiendishly complicated contractual add-ons.
In addition in many of our most deprived communities, where GPs are most stretched, recruitment is hardest and health needs are the greatest, the levels of investment in primary care are at their lowest. It will be seven years before the recent GMS changes will deliver anything near parity in funding for many practices. Our patients can’t wait that long!
Given all of this I think it is CCGs and not NHS England that are best placed to support innovative new models of primary care that are essential to delivering truly coordinated care for our patients.
Yes, the appropriate checks and balances must be in place, but my proposal is that some CCGs should be allowed to test out with their member practices new ways of working across local health systems.
And where necessary this should involve looking at new contractual models. A group of integration pioneer sites are soon to be identified across England - surely an ideal opportunity to test out some of these ideas?
Hugh Reeve is clinical chair of NHS Cumbria CCG and a GP partner in Grange-over-Sands