One of the biggest hospital trusts in England wants to convert itself into a vertically integrated care organisation.
Imperial College Healthcare trust chief executive Steve Smith told HSJ he wants to create a large integrated provider in the mould of healthcare management organisations in the US and elsewhere.
Imperial - which had an estimated income of £898m in 2009-10 - has already started working more closely with GPs in its area of London in recent months but Professor Smith said many “fear” integration with a hospital trust.
He added his voice to those calling for integrated providers in the UK. They say at present it is in acute providers’ interests to treat more patients in hospital. But if they joined with GPs and were paid a fixed fee to look after individuals, they would be incentivised to keep them well and out of hospital.
Creating integrated providers will require support from politicians as well as commissioners and GPs.
Professor Smith said: “There’s got to be a financial incentive to help keep patients out of hospital rather than dragging them in. The new healthcare policy has to take into account this much more preventative approach.
“There is evidence from abroad that where you have competition between integrated healthcare systems your opportunity of delivering the preventative agenda is much greater than where you have competition between horizontal systems. Competition between primary and secondary care is probably unhelpful.”
Professor Smith said some GPs were enthusiastic but some were suspicious. Some believe hospitals will use integration to “suck in” patients and funding from community and primary care.
Professor Smith said: “We are all in the same business and it is our responsibility to make sure we are not feared as an organisation.”
But he said GPs’ potential to improve public health relied on them working closely with specialists, who will continue to be based in hospital.
He said: “If a hospital is in collaboration with GPs, is doing everything it can to make sure there is prevention and keeping patients closer to home, it can be part of the solution. Hospitals have to be the solution because the knowledge around conditions resides in hospitals.”