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Service Development - Integrated care organisations

Gemma McKenna describes a new model for services that brings GPs and consultants together.

Lord Darzi's long-awaited NHS Next Stage Review introduced the concept of integrated care organisations (ICOs) but, so far, little detail has followed.

A national pilot scheme is due to be announced soon, so now is the time to find out how ICOs could work and whether your practice should be involved.

Eleanor Brown and GP Dr Howard Freeman say the proposed ICO offers real opportunities

What is an ICO?
In Lord Darzi's document, ICOs are defined as 'multi-professional groups based around groups of GP practices'.

They would be designed to break down the barriers between specialist and generalist services to provide seamless care for patients. NHS Alliance chair Dr Michael Dixon describes them as 'hospital and GP doctors working together, not necessarily under one roof, to co-produce care'.

'There is a lot of medicine done in the UK which needs to be in the community, as it is in Europe,' he says.

Dr Dixon envisages an ICO would have a population, based on registered patient lists, of 50,000 to 200,000 patients.

ICOs will involve collaboration across primary, community and secondary care boundaries, taking into account health and social care partnerships. PCTs would contract with ICOs as service providers.

Surrey GP Dr Tim Richardson is hoping to be one of the first pilots. He says: 'ICOs differ from practice-based commissioning because the practice moves from being a commissioner with limited access to a budget, to being a provider with responsibility for a hard budget.'

Will it be one size fits all?
The NHS Alliance has called for flexibility and local decision-making on which of a number of possible models could be adopted in any particular area.

Dr Dixon has set out a proposed framework for the ICO pilots, which recommends goals for clinical quality, and financial accountability, patient involvement and collaborative working.

The alliance also wants an emphasis on the prevention and reduction of ill health, clinical leadership and a requirement that proposals should cover the whole disease spectrum to avoid cherry picking.

Any more details?
Pilot sites and start dates have not yet been announced. Commentators are suggesting anything between 15 and 40 pilot sites across the country.

ICOs can join forces with a partner organisation, such as a private sector healthcare provider, to help manage risk.

The pilots will be independently assessed. Dr Dixon says that the evaluating body 'will look at patient experience, costs, perceived benefits to those working in the ICO, and benefits to the PCT.'

Can my practice take part?
Yes, in theory. First talk to neighbouring practices and find out if you have a common interest. You would need to agree reasons for working together, and your main areas of focus.

Then call a meeting of all concerned, including hospital specialists and PCT representatives.

Decide on your goals and then go to the PCT with an outline of your plan. This should explain how services will become more efficient and how budget savings will be made.

How much work is it?
Setting up an ICO is likely to be demanding.

Member practices will need to demonstrate a track record in innovation, that they have PCT support, acute providers who want to work with them, plus management and financial backing.

Practices could seek help from organisations such as Integrated Health Partners (IHP), a new company offering to redesign the interface between GPs and consultants, along the lines of Kaiser Permanente in the USA.

Case study
South West London GP Dr Howard Freeman is a senior partner in a GP partnership covering seven GP practices. He believes integrated care organisations (ICOs) are long overdue and is hoping to become a pilot site. 'Evidence from abroad suggests that integrated care brings huge benefits to patient care as well as improving the pathway,' he says.

Eleanor Brown, chief executive for the Nelson Commissioning Group in Sutton and Merton PCT, of which Dr Freeman's practice is a member, explains: 'Our practice-based commissioning group is made up of 14 practices, which includes 100 GPs and 150,000 patients.'

'We've been working together as a PBC group for nearly three years. An ICO seems like a natural step for us, where we can work with a real budget and not just an indicative one. The beauty is that it gives you the clout to make things happen. PBC can be a slow process.

'We're planning to integrate our pathway with secondary and community care, and we're even looking at some third sector organisations - such as charities or social enterprises - for things like end-of-life care. The ICO might join up with a partner company to help us absorb the risk.'

Ms Brown says she is confident that the group is ready to become a pilot. 'For those considering it, I'd say, work out what you want to deliver and start off in bite-size chunks.'

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