Senior figures in healthcare have questioned moves by clinical commissioning groups to introduce “integrated” care pathways for single clinical specialisms, such as cancer or cardiology.

The King’s Fund think tank has led calls for a focus on integrated care in recent years. However, several of its leaders told HSJ they were now concerned that redesigned services focused on a single issue – described as “carve-outs” – could cause fragmentation, and create new “silos”.

HSJ reported last month that many CCGs had begun tendering, or were planning to tender, for contracts to provide redesigned services for single-specialism care pathways.

Examples include Bedfordshire CCG, which plans to contract Circle as its prime provider for all musculoskeletal services; Bexley CCG, which is consulting providers over integrating cardiac services; and Tameside and Glossop CCG, which is planning a single contract for diabetes care.

Meanwhile, a group of Staffordshire CCGs wants to establish a single contract for cancer services.

King’s Fund senior policy fellow Nigel Edwards told HSJ: “The minute you bunch stuff up together, you run the risk of creating new and different problems with integration.

“If you integrate one vertical silo you create new opportunities for a lack of integration with other ones.”

Some contracts currently being considered appeared to be a “carve out” of particular services rather than an integration project, he added.

Mr Edwards said integrated services should ideally cover a broader population than a cohort of patients with a particular condition.

He said separating specialisms was more problematic for conditions whose care pathways more commonly overlap with others, such as cardiac or cancer care. In these cases a patient with more than one long term condition could see their care fragmented between separate contracts.

Mr Edwards said it was less of a problem for specialisms such as musculoskeletal, which are were relatively self-contained.

King’s Fund chief executive Chris Ham, commenting on the Staffordshire cancer plan, said on Twitter that creating a series of silos around clinical specialisms would be “the wrong kind of integration”.

West Suffolk Foundation Trust medical director Dermot O’Riordan, also chair of the east of England clinical senate, said a “high proportion of elderly have at least two long term conditions so doing it [contracting] by specialty isn’t patient centred”.