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Integrated Care in the UK: Obstacles, Experiments and Uncertainties

By: and :: Published: November 14, 2014

“A further new option will be the integrated hospital and primary care provider – Primary and Acute Care Systems – combining for the first time general practice and hospital services.”

–NHS, Five Year Forward View, October 2014

The UK’s National Health Service (NHS) recently published its “Five Year Forward View” to meet new challenges that developments in healthcare have engendered in the UK. In the report, the NHS identifies the separation of primary care, hospitals and community services as a barrier to the personalized and coordinated health services that patients today need. For example, cancer patients need coordinated mental health and social care in addition to cancer treatment. Mental health patients need their physical health treated simultaneously.

The NHS now permits single organizations to provide NHS list-based general practice and hospital services, together with mental health and community care services. These vertically integrated systems are called Primary Acute Care Systems (PACS) and may be generated from various places within different local health economies across England. Does any of this sound familiar? For those in tune with the Affordable Care Act, it should. Chapter three of the NHS’s plan states: “At their most radical, PACS would take accountability for the whole health needs of a registered list of patients, under a delegated capitated budget — similar to the Accountable Care Organisations (ACOs) that are emerging in Spain, the United States, Singapore and a number of other countries.” The NHS intends to work with a small number of areas to test PACS to develop prototypes that work, before promoting the best models for adoption by the wider NHS.

Integrated care pioneers have shown early promise in the UK. Organizations that combine NHS, general practitioner and social care services have improved services for patients — with fewer people moving permanently into nursing care homes — and have reduced emergency admissions. Greenwich has saved nearly £1m for the local authority and over 5% of the community health expenditure due to integrated care delivery.

However, the NHS acknowledges uncertainty around the new care delivery models. They state that the prospect of PACS contains “potential unintended side effects that need to be managed.” The NHS also recognizes that the implementation of PACS will require time and technical expertise. Additionally, in taking a broader view of the healthcare structure of the UK, significant barriers to achieving integrated care appear. Budgets within the NHS (General Medical Services and Hospital and Community Health Service) and between the NHS and social services are separated. A lack of integrated data and information systems between care providers exists. There is also an absence of effective joint commissioning between the NHS and local authorities.

UK organizations are undertaking efforts to overcome these barriers. The Coalition Government has established the Better Care Fund as a single pooled budget of €3.8 billion to support health and social care services to work more closely together. Additionally, an integrated pioneer program supports 14 areas across the UK that plan to develop and implement integrated care models that are similar to ACOs. In Staffordshire, two clinical commissioning groups (CCGs) are working with Macmillan Cancer Support to redesign cancer care services for the county.

The NHS recognizes the need for integrated care in the UK but is cautious in its planning to implement the ACO care delivery model. Integrated care remains in the experimental phase within the UK healthcare environment — even more so than integrated care in the US. Widespread ACO success in the US could push the NHS to adopt integrated care delivery across England.

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