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15-01-2012 | Article

Integrated care is already our priority

The one constant about our working environment in General Practice is, paradoxically, that it never remains constant. Face-to-face consultations with patients have been the cornerstone of primary care and in the immediate future that is unlikely to change. However, there has recently been an increase in telephone consultations and we may even be using "Skype" forms of consultations as time goes on.

Outside the consultation, our contractual responsibilities seem to be ever changing, and the next revision appearing on the horizon is the concept of integrated care. According to the univadis GP News service (click here), the government, in its official response to the NHS Future Forum's second report, says it "supports all of the Forum's recommendations on integrated care".

In the linked Department of Health report (click here), it mentions that "the Forum pointed out the importance of services based around people and not disease pathways". The GP News report states that "GPs could be incentivised through the QOF on how well they deliver integrated care to their patients" (click here); Pulse carried a similar article (click here).

Confused? You may not be alone. GPs are major followers and advocates of holistic care, treating the patient as a whole and putting them at the centre of their care. Yes, within the NHS there has been some "splintering" of services, and all units are guilty to some extent of not communicating with each other enough to achieve this. But focusing on GPs does not seem the most logical approach. GPs are often the only frontline healthcare provider trying to co-ordinate care and to be the patient's advocate. Furthermore, disease pathways may be managed by other agencies, and yet it is still the GP who is expected to deliver integrated care. While there is always room to increase our effectiveness and efficiency, including our practice of integrated care, I do not think this is as big an issue for primary care as for other sectors of health and social care.

As always, the devil will be in the detail, should this policy come on to the front line. If, as reported, the aim is to alter the GP contract to reflect the importance of integrated care, I hope this will be an achievable goal - it remains unclear where any money used to promote this will come from. I doubt if it will be new cash, bearing in mind the current economic climate. The problem could be deciding which resources will be sacrificed to fund this new project. That could generate further controversy and yet another change in contractual obligations. Watch this space.

Best wishes,


Dr Harry Brown, editor-in-chief univadis

By Dr Harry Brown