'Integrated care' is one of the main ways in which the government hopes the Health and Social Care Act will improve patient care.
Integrating services has been hailed as the solution to improve otoutcomes, especially for the elderly and patients with complex needs, as well as enabling costs to be cut.
The DH definition of integrated care is 'when health and social care services work together to ensure individuals get the right treatment and care they need for their health concerns.’
NHS Future Forum chairman Professor Steve Field is certain that integrated care is key to improving outcomes for patients. ‘I think the way forward is collaboration and coordination with patients at the centre,’ he says.
Integration involves colleagues in primary, social and secondary care working together to create multi-disciplinary teams with GPs at the centre, RCGP vice chairman Professor Nigel Mathers says.
‘We’re saying it should be GP-led. The primary care position has to be at the centre of all of this,’ he adds.
Nick Goodwin PhD, senior fellow at the King's Fund agrees: ‘Wherever you look in the world, the role of the primary care physician, and in England the GP, is absolutely key to the process. This is the hub around which the system needs to operate.
But for GPs to deliver integrated care and create these teams they would need ‘to build up capacity, with more staff and more skills,’ Dr Goodwin says. For example, GP practices might wish to employ a nurse to coordinate integrating services.
There are other requirements needed to successfully integrate health and social care, Dr Rebecca Rosen, a GP in south-east London and senior fellow in health policy at the Nuffield Trust, explains. She says that a top priority is the need for ‘risk stratification tools’ to allow clinicians to predict the likelihood that a patient will be ill in the future.
‘What you need to do is find ways of predicting who will become ill next year,’ Dr Rosen says, adding that the second key ingredient is GP practices sharing patient records with other providers.
Professor Field agrees, but is clear that this process of sharing records must be owned by patients. ‘We have pushed very hard, saying that the patient should feel that they own their records,’ he says.
Some GPs have questioned how the changes needed to successfully integrate care can be made without injecting more funding into general practice. GPC deputy chairman Dr Richard Vautrey believes that integrating services is a resource issue. ‘To do this you need more "stuff",’ he says.
But this is not Professor Field’s view. ‘Sometimes investment is needed, but a lot can be done without extra money,’ he says.
One of the main barriers to integration, which was highlighted by the second Future Forum report, could be the introduction of competition and a greater range of healthcare providers - ironically, something that is central to the Health and Social Care Act Act.
‘It is very difficult to integrate care against a backdrop of multiple providers,' Professor Mathers says.
However Professor Field does not believe this will hinder integration. ‘We’ve got lots of providers now and patients say it’s a disjointed system,' he argues.
The role of federations
One way that GPs could overcome the problems of competition between providers could be to federate and work with those companies. ‘They would do all of the things GPs don’t have time to do,’ Dr Goodwin says.
While GPs in general welcome the idea of integrated services, there is concern that many will be less keen to get involved in the actual implementation. Professor Mathers says that integrating social care and GP care has been successful in his own practice, but it has taken a lot of work.
‘It does work well but it takes a huge amount of energy and time and commitment. It’s not sustainable without additional resources,’ he says.
Dr Vaurtry adds: ‘It sounds great in theory, but delivering it in reality is something else.’