The Royal College of General Practitioners (RCGP) has launched a consultation on what integrated care - a major focus of the Health and Social Care Bill - means for general practice and GPs.

An integrated care service is designed to meet the needs of the patient, rather than of the organisational structure, providing high-quality and effective services at the right time and in the right place, and improving patients' experiences and outcomes, says the RCGP.

The College notes that it has been an early champion of integration; for example, it has showcased models of mixed generalist and specialist teams working across the primary and secondary care divide, made recommendations for improved collaboration between GPs and community pharmacists, and developed a model of Primary Care Federations of GP practices, providers and other services working in partnership to meet local needs, it says.

Evidence shows that significant benefits can arise from the development of well-functioning integrated services. However, as it now stands the Health and Social Bill presents a range of concerns, challenges and risks to integrated care, says the College, and it believes that the most significant of these are:
- tensions between integration and competition and choice;
- who leads on integration - commissioners or providers?
- the role of the GP as provider and commissioner;
- perverse incentives of the current payment system - a system which incentivises providers to increase activity and use the most costly interventions to increase income is contrary to the role of primary care to reduce the need for secondary care, manage budgets, prevent and treat conditions early and provide services closer to home, says the College;
- increased bureaucracy;
- the need for adequate leadership and engagement to deliver integrated services;
- the need for adequate specialist and clinical advice;
- shared boundaries between health and social care populations and services;
- the role of IT and the electronic patient record in information-sharing;
- aligning outcomes and performance across integrated care systems;
- reducing health inequalities and improving equity of care in the new system; and
- disease versus population commissioning - integration must not lead to new barriers between services, such as condition-specific services and silos of care provision, it says.

The College has posed a number of questions based on these concerns which are answerable via its online survey (, which it will use to develop a policy that can guide decision-making and service design. It will also use the consultation feedback received to respond to the NHS Future Forum, which is gathering views on integration to provide further advice to the Department of Health, it says.