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GPs lead the way on integrated care

Fiona Barr talks to the GP lead for an integrated care pilot involving six practices and a healthcare company.

A group of Guildford GPs believe they have found the key to delivering more integrated care and saving the NHS money.

Six practices in the Surrey city have brought in a private sector partner and set up one of the first integrated care organisations (ICOs) in the country.

Born out of frustration with the lack of progress on practice-based commissioning (PBC), the pilot's GP lead Dr David Eyre-Brook says patients are seeing benefits just six months after the launch of Guildford IHP Partnership.

Dr Eyre-Brook, also the PBC consortium lead for 10 local practices, explains that last year, with the consortium not getting very far, it came across Integrated Health Partners (IHP). The company is run by former neurologist Dr Oliver Bernath who used to work for US health maintenance organisation, Kaiser Permanente.

'When I met Oliver I felt that he was talking the same sort of language as us,' he says.

IHP proposed working with interested consortium practices to run an ICO with a devolved budget for defined services. The company would provide the infrastructure and capital funding needed plus expertise in areas such as Payment by Results (PbR) claims validation. The practices would identify needed service changes and help deliver them.

With the backing of NHS Surrey, six of the practices joined with IHP to set up the Guildford IHP Partnership and to take part in a one-year pilot.

Dr Eyre-Brook says the ICO is currently on target to make 5 to 7 per cent savings against the group's PBC budget for PbR activity and prescribing.

'The practices are working together and there is a positive feeling,' he says.

The ICO is focusing on eight distinct projects with different practices or their partner IHP taking a lead. These include assessing whether placing a GP or primary care-focused nurse practitioner in A & E would lead to fewer admissions.

The ICO ran a series of audits with the hospital and concluded that it is more effective to combine a walk-in centre with A&E.

Medicines management
Another project was a 'single point of access' phone number for GPs and community matrons considering emergency admissions.

Other projects include using GPSI services more effectively; subjecting GP referrals to closer examination; improving end of life care for non-cancer patients, and scrutinising medicines management with an emphasis on cost-effective prescribing.

IHP Ltd has concentrated on PbR claims validation and data analysis. 'The company is good at analysing data and providing us with answers,' says Dr Eyre Brook.

A key advantage of the pilot is that the practices are able to make changes and feel a sense of achievement. 'It's really positive and the local hospital is responding,' he says.

But there is a time commitment with meetings to attend and tasks to do although the practices have PCT funding to pay for extra locum help.

Dr Eyre-Brook says other GPs considering setting up an ICO have to be prepared to be open with each other and share their data. The practices must also ensure their patients are aware of what they are doing and why.


  • One year pilot covering 73,500 patients from six practices.
  • The pilot is testing team-based care which it wants patients to experience as a single service.
  • Eight projects identified for first year including review of A&E services to reduce admissions and closer working between health and social care on chronic disease management.
  • Any savings go back to the PCT, but future savings will go back to the ICO if it continues beyond the end of the pilot.


  • Dapdune House Surgery
  • St Lukes Surgery
  • Woodbridge Hill Medical Practice
  • Guildowns Group Practice
  • Shere Surgery & Dispensary
  • Wonersh Medical Practice
  • Integrated Health Partners Limited (www.ihpclinics.com)

Read 'An integrated pilot takes off' by Dr Oliver Bernath

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