Giving GPs responsibility for commissioning alongside service provision is crucial for better integration of health services and thus overall outcomes, a report by The Nuffield Trust has concluded.

According to the Trust, experience on the international scene shows that integrating healthcare services can secure more efficient, patient-focused care, and it says the government’s White Paper Equity and Excellence: Liberating the NHS provides an opportunity for the NHS to move towards such integrated systems, enabling it to deliver “high-quality and responsive care at reasonable cost”.

The report, Removing the policy barriers to integrated care in England, concludes that many of the strands of reform put forward in the White Paper have the potential to ensure more seamless care for patients, and it singles out GP commissioning as a key factor in doing so, as long as secondary care clinicians are involved alongside primary care teams right from the outset.

Aside from closer link between primary and secondary care, there are also a number of other barriers that must be overcome in order to create a more integrated health environment.

For one, the government should recognise the need for competition and choice in some areas of care, such as when choosing GPs or diagnostic testing, and collaboration in others, such as co-ordinated approaches to care from different providers for patients with chronic illnesses.

While many of the current incentives in the health service have been created to boost competition and choice, the report says those for encouraging collaboration and integration are lacking, and it calls on policymakers to use incentives such as capitated budgets, i.e. paying GPs for each patient on their books, to help foster more integrated care.

Competition and integration 'faesible'

“While the evidence base is still mixed, encouraging integration between providers of care is the most rational way forward to reduce fragmented care, the avoidable ill health it produces, and to improve efficiency,” said Nuffield Trust Head of Policy Judith Smith, co-author of the report, and she noted that “competition does challenge the idea of integrated care organisations but it’s certainly feasible to create a system where there is an appropriate degree of competition between providers, whilst assuring co-ordination of services across general practice, hospital and other sectors”.

“Patients expect health and social care providers to work together to deliver high quality care but this is often not the case,” added fellow report co-author Professor Chris Ham, chief executive of The King’s Fund, and he stressed that the government “must do more to break down barriers to integration through smarter regulation and aligned incentives”.