The NHS Alliance has called on several organisations to pull together to help clinicians lead the looming integration of primary and secondary healthcare services.

The move comes as government policies are pushing care out of the hospital and into the community, making closer collaboration between primary and secondary care a necessity in order to deal with the growing emphasis on competition between the two factions.

In its new discussion paper, Integrated healthcare services – the future of commissioning and provision of out of hospital healthcare in the NHS, the Alliance claims that “current policies around practice-based commissioning, payment by results and plurality of providers have introduced competition at the most vulnerable interface: between primary and secondary healthcare services.”

It stresses that primary care trusts and foundation trusts have “exactly opposite priorities for demand management”, which has fed the deterioration in relationships between GPs and consultants, managers and clinicians, across the board. But, “since patients with long-term conditions experience the interface between primary, community and secondary healthcare, a culture of clinical collaboration would be more suitable to provide flexible and responsive healthcare services in their journey through the healthcare system,” it argues.

The report says the NHS Next Stage Review, currently underway by Professor Sir Ara Darzi, presents a good opportunity to take a look at some of the unintended consequences of recent healthcare reforms, and draw up new policy that is “evidence based and promotes healthy competition and collaboration between various components of the health service”, which is essential to improve the service.

Furthermore, it suggests that integration could be achieved by strengthening PBC, which would “enable clinicians to collaborate and lead positive change within the health service through innovation, while ensuring that the local population is truly engaged with preventative healthcare and enjoys the benefits of a flexible, responsive and patient centred health service”.

Gluing service together
The paper suggests “practical solutions” it claims meet the needs of the patient in this new healthcare environment and glue the health service together, including the introduction of Integrated Provider Organisations, based around PBC groups, and the creation of a new medical professional – the community specialist of consultant - whose expertise and status would be equivalent to their hospital-based peers.

The Alliance envisages a new partnership with the Academy of Royal Colleges, the Royal College of Physicians, the Royal College of General Practitioners and the British Medical Association to help clinicians develop a seamless healthcare system, rather than wait for “the imposition of structural change from above”.

“We have long argued for greater collaboration at the clinical interface between primary and secondary care,” commented NHS Alliance chairman Dr Michael Dixon. “The solution we’ve put forward is practical, achievable and cost effective. Now we hope our secondary care colleagues will join with us in developing it further”, he added.