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Focus on… long-term conditions

Competition and choice, watchwords of the Government's reforms, ensure the health bill continues to be dogged with controversy – but neither are among the loudest demands of patients, carers and their organisations.

Clinical commissioners, already well aware that better management of long-term conditions should be a priority for the NHS, might be comforted to know that when the 130 member organisations of National Voices were consulted during the first Future Forum, the biggest of our ‘nine big shouts' for change was for ‘integration' – as a pathway to a new deal for people with long-term and recurring conditions. If patients, professionals and commissioners can find common ground in the reorganisation of services, much of the tension of NHS reform can be eased. So it is important for GPs and CCGs to grasp the patient point of view.

Patients want co-ordination. Integration in its true sense – joining up organisations or structures – may not be necessary. Patients expect professionals to work together in a ‘team around the patient', and they want services to work in the same way, coming together at the point they are needed and meeting people's needs in the round. People want care. Where it comes from is secondary. Divisions into ‘primary', ‘secondary', ‘community' and ‘social' care are relatively meaningless.

As Sir John Oldham, national clinical lead for quality and productivity at the Department of Health, says in the interview on page 20, it is ‘how you configure integrated care teams' that is at the heart of the QIPP model. 

National Voices found that from the patient's end what matters most is for care co-ordination to be tangible, concluding: ‘Every integrated care programme must include detailed specification of where, how and by whom the care co-ordination function will be provided for targeted groups of patients – or it will fail.'

Think tanks advising the Government on its strategy for integrated care agreed.

So commissioners need to work with their providers to design new multidisciplinary team working, with clear arrangements for identifying, risk stratifying and case managing their local populations. Barking and Dagenham (page 25) is one of a range of models for how to do that. CCGs' collaborators need to include mental health services, since mental and physical health are still not being treated together, though depression is closely associated with long-term conditions. GPs themselves have said they would benefit from greater investment in their training and education in mental health and its relationship to physical health.

Collaborators should also include ‘expert patients' and patient groups. Co-designed services are much more likely to get it right first time than those developed without patient input, and patient organisations are used to providing the co-ordinating ‘glue' and the information and navigation support that patients most need. It was one such collaboration, involving Diabetes UK, that demonstrated the value of the ‘year of care' approach (which is also featured here, on page 30) and which the RCGP has adopted as its model for all long-term conditions.

Commissioners and GPs will do well to study and adopt its key elements of personalised care planning, information integration, and patient activation. Look, too, at the significant role of ‘non-traditional' providers in this mix.

Don Redding is director of policy for National Voices