Editorial - CCGs face huge challenge to integrate care

One of the themes to emerge from last week's RCGP annual conference was the future of generalism. In her speech, chairwoman Dr Clare Gerada emphasised the importance of the patient-doctor relationship calling for GPs to ensure that patients are always put first in the NHS.

The value of generalism lies in providing holistic care. The majority of people seen by GPs in the surgery do not just have one medical complaint. It is often a series of issues, many not even linked to physical health.

The publication this week of the BMA's National Survey of GP Opinion reflects this. Some 88 per cent of GPs said that the intensity of their consultations had increased in the last five years and 84 per cent said the complexity of their consultations had increased.

Many patients have complex needs that involve GPs, community services, hospitals, social care and other local services. For these individuals, negotiating the system can be baffling. Most may have fantastic experiences of the individual components of their care but, as a whole, their 'journey' through the system may feel confused, haphazard and stressful. These people would surely welcome greater integration.

Integration is the buzz-word of the moment in the NHS. It is effectively generalism on a system-wide scale - an attempt to provide holistic care.

But there are huge barriers to achieving this, not least Payment by Results, which rewards hospitals for increasing activity. The DoH is now considering how it can incentivise providers and commissioners to deliver integration. But whether it can even be achieved in a market-based system is questionable. Arguably, increasing the number of providers will make integration even harder.

Of course, the onus to achieve this, along with so much else, now falls on clinical commissioning groups. Commissioners will need to heed Dr Gerada's words and put patients at the heart of every decision they make if they are to succeed.

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