Viewpoint: How Spain has gone a step further than community and GP integration

Since I last wrote, I've been over to Spain, specifically to the Ribera Salud organisation in a place called Alzira, just outside Valencia.

Now, after that opening statement a lot of people will have just clicked on another link and drifted off, believing that the NHS has little to learn from anywhere else because ‘we’re different’.

OK, so here’s how different we are from Spain. We both use a Bismarckian model to fund healthcare, as does Denmark, we’re both facing a financial and demographic crisis and we’re both searching for solutions around integration.

NHS England’s deputy medical director Dr Mike Bewick is talking of community and GP integration. In Spain its gone further, Ribera Salud covers a populations specialist, generalist, urgent and planned care for a budget of circa £545 per head per year. A&E attendances are dropping, outpatient referrals are falling, self care is a growth industry, quality and satisfaction with healthcare is rising.

Obviously it has achieved the impossible.

The secret?

Local autonomy, vertical integration, and freedom to deliver services in the right place at the right time by the right person, to the right quality are all present.

Would it ever work here?

It’s possible. GPs as independent contractors have become part of the Ribera Salud organisation, some became salaried others remained public servants.

All receive benefits when the organisation delivers efficiencies and improved outcomes and experience.  The capitation-based contract supports innovation and system redesign.

It won’t happen

As it turns out both Liam Fox and shadow health secretary Andy Burnham have been to see the system. I’m led to believe that oddly, despite the public private partnership which underlines the success of the organisation, Dr Fox was none too keen.  Apparently Mr Burnham on the other hand saw it as a local solution to a national issue and one worth considering.


I’m just going to add it to the possibilities I might choose to consider if I were ever to become secretary of state for health.

  • Dr Chris Mimnagh is a GP and co-director of clincial strategy at Liverpool Health Partners.

Photo: UNP

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