INTEGRATED CARE
as GPs, consultants, nurses and other health professionals how quickly a common view could be reached on what people would like to do.
“It is then a big management challenge to ensure that we make the system support what we want to deliver as better care in the future,” said Stern. “The most important imperative in the health service is that we start being a lot braver at how we work together and how we do things that are good for patients, rather than things which support the individual interests of professions or organisations.”
Getting primary care right
Both Hopson and Stern added that there are lots of different ways that barriers can start to be broken down. They also discussed the various care models suggested in the recent Five Year Forward View.
For example, they noted how important the new primary and acute care systems, which combine for the first time general practice and hospital services, similar to the accountable care organisations now developing in other countries too, could be.
Hopson said: “I’m incredibly struck how over the last year how many members of the FTN have said ‘we can’t do our job properly unless we get the relationship with primary care right’. There is a real sense that primary care, in its broadest sense, is such a key part of local healthcare provision. But unless we can get the join-up right it really doesn’t work.
“You only have to look at some of the international examples, such as accountable care organisations in the USA, where people have been able to not only provide much better outcomes for patients, but a better experience for the workforce and provide care more effectively and efficiently when people have done that ‘vertical integration’.”
During the interview with NHE, the partners stated that any changes in the future should not be about how hospitals can take over primary care or how general practice can ensure that hospitals can do what they want, but it is about how the different parts of the system can come together in new and creative ways.
They added that the conversations around integrated care are getting ‘increasingly joined- up’, but turning it into practical reality is always much harder.
Breaking down historic interests
Stern noted, however, that the partnerships and the conversations being had “offer a real sense that it’s possible to do things in a different way”.
He added that, traditionally, primary and secondary care have been positioned as having very different interests, “but as soon as we started talking to each other it was clear that we had common values and collectively we’re all looking to improve care and address some of the major pressures on the system”.
It was suggested that there should be some
national level involvement about what the overall direction of travel might be with regards to integration.
“But we feel very strongly that the Five Year Forward View, which looks at a number of different ways of bringing services together, is a step in the right direction,” said Hopson. “A one-size-fits-all approach won’t work, but equally there won’t be a thousand ways of doing this. What is great to see is the ambition that it is really up to the local health and social care economies to identify which route they wish to go down and pursue.”
FTN and NHS Alliance will collaborate over the next six months and continue gathering, discussing and communicating how primary and secondary care providers can deliver better integrated care. Although a fixed timetable is not set, Stern said: “I imagine our members on both sides will have a number of thoughts, but if at the end of our work we can come up with something useful to support and encourage the debate whether nationally or locally then that would be great.”
Chris Hopson
Rick Stern
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
national health executive Nov/Dec 14 | 49
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