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Primary care must be at the heart of the delivery of integrated care. Our recent report to the Department of Health and the Future Forum, written in partnership with Nuffield Trust, argued that for this to happen, general practice must change in two important ways.
First, practices must operate at scale to deliver integrated services and achieve effective collaboration with other clinicians. This does not mean practices relinquishing their independence. Rather, it requires them to work together in a more corporate way, recognising their collective interest, and potentially using the mechanism of federations
Second, these groups of practices must work closely with staff in community health services and social care to make a reality of joined-up care close to home. One option is for groups or federations of practices to work hand-in-hand with integrated community teams, ideally covering both health and social care. This in turn creates the potential for engaging specialists.
These proposals were echoed in this week's report from the Future Forum, suggesting that there is an emerging consensus on the new model needed to make a reality of integrated care. The challenge is how to act on this consensus when some of the policies being pursued by the government may lead to greater fragmentation rather than increased integration. A further challenge is how to find time and resources for new services when there are increasing financial and service pressures facing the NHS.
Our recent conference on integrated care showcased several impressive examples of NHS organisations, sometimes in partnership with local authorities, already delivering integrated care. These examples demonstrate what can be achieved when local leaders get on and do the right thing – despite the obstacles in the way.
To take integrated care forward, local leadership now needs to be matched by leadership in the government. Despite a pledge to develop new metrics bringing together patient experience and care co-ordination by April, the Department of Health's response to the Future Forum's report was long on warm words and good intentions but worryingly short on specific, credible commitments. The risk this creates is that integrated care will only be implemented in pockets of innovation, and that good practice will not be adopted across England.
To avoid this risk, the government should do two things: first, the mandate issued by the Secretary of State to the NHS Commissioning Board should ensure that integrated care is a high priority for the Board. As the Fund argued in its report, there needs to be a clear and measurable objective for improving integrated care, given the same priority as the 18-week waiting list target that was so influential in improving access to elective care.
Second, the government should revisit the NHS Constitution and ensure that it includes guarantees to people with complex needs. These guarantees should include people having a care plan and a care manager responsible for co-ordinating their care.
A recent briefing from National Voices underlines the importance of integrated care to patients. Only by making specific, credible commitments will ministers convince us that they are serious when they say that integrated care is a priority for the future.