Breaking down barriers between healthcare professionals in primary and secondary care is emerging as a key element of the NHS reforms, to provide a seamless service focused on the needs of patients.
But Professor Chris Ham, chief executive of healthcare thinktank The King's Fund, has warned clinical commissioning groups to avoid disease-based models.
‘Personally I am cautious about going too far down a road towards a disease-based route to integration.
‘My concern is that if we do that we might end up in three years’ time in a city or county with an integrated diabetes services co-existing with an integrated respiratory service and so on.
‘We’ll have just created new silos to replace the old silos we are breaking down. We need to focus much more on integration around populations rather than diseases, and populations of people with complex needs.’
Professor Ham said GPs were in pole position as commissioners to develop new models of integrated care, and would have the power to improve on the work of PCTs.
He said there were three levels of integrated care:
- Macro-level integration – a single organisation or network takes full clinical and fiscal responsibility for the spectrum of health services for a defined population.
- Meso-level integration – integration of services for patients with particular conditions.
- Micro-level integration – co-ordination of care for individual patients with complex needs.
He also advocated a ‘nuanced approach’ to the use of competition and collaboration in healthcare services.
‘Competition is particularly important in relation to planned and elective care - including access to diagnostic services - where it’s much more feasible to think about patients to exercising informed choices and being able to shop around.
‘That need not be incompatible with collaboration, where organisations work together, particularly in relation to unplanned care and people with complex needs. And if you look at the figures for use and spend, most areas of healthcare are focused on people with unplanned needs.’