Government must remove barriers to integrated care, warns King's Fund

The think tank warned in a discussion paper that the coalition government’s proposed reforms could make it more difficult to achieve closer integration of care unless they are modified.

One of the barriers, according to the King’s Fund, is Monitor’s proposed role as the economic regulator, promoting competition.

The paper states: “Monitor must adopt a nuanced and proportionate approach that encourages both collaboration and competition where appropriate.”

King’s Fund chief executive Chris Ham told HSJ this would involve changes to the bill, for example by requiring Monitor to promote collaboration.

Changing the wording of the bill “won’t have a huge impact” but would be “symbolically important”, he said.

Where next for the NHS reforms? The case for integrated care also highlights the danger that GP consortia could inhibit integration due to their continuation of the provider/commissioner split.

It says: “This is because commissioning consortia as statutory bodies will not have the flexibilities to take the decisions to either provide services directly or commission them from others that are needed to implement integrated care.”

In addition, it “is likely to deter some of the most innovative clinicians from playing a full part in commissioning because these clinicians are interested mainly in improving service provision by developing new models of care”.

Drawing on experience from the US, it recommends that integrated medical groups could act as providers and commissioners.

It also suggests networks of primary providers could act as “hubs”, providing access to diagnostics and chronic disease management as well as “generalist care”.

Professor Ham said a way of avoiding consortia being dominated by vested interests was “proper accountability for how decisions are made and proper transparent regulation through the NHS Commissioning Board looking at how consortia are supporting these new models of provision.”

The report concludes by warning that its ideas “must be taken forward as a matter of urgency to remove barriers to the delivery of integrated care and to tackle the core challenge of an ageing population in which chronic medical conditions represent a threat to the sustainability of a universal, tax-funded healthcare system”.