Integrated care heightens provider monopolies risk

Experts are predicting that under integrated care models, large amounts of money are likely to be consolidated in the hands of new groups straddling primary, community, social and even hospital care.

As HSJ revealed last week, a pilot of integrated care schemes is strongly tipped to feature in the Darzi review, due out at the end of the month.

And in a report published today, Altogether Now? Policy options for integrating care, which explores different urgent care models open to the NHS, Birmingham University's health services management centre states the Darzi strategy is likely to feature new models emphasising "a more effective integration of primary and secondary care".

Report co-author Chris Ham said: "There are a lot of people from different positions saying what we're trying to argue in the paper. The big risk is that if the government does nothing, we'll end up with continuing and probably increasing fragmentation."

He said the potential benefit was that patients would receive "properly co-ordinated" care and that some problems caused by the divide between GPs, hospitals and social care would be avoided. But he added the risk was that patients would have to get their care from integrated care organisations which had become "slow-moving monopoly providers". He said: "It's important that patients should still be able to exercise choice."

PCT Network director David Stout said strategic commissioning at PCT level would be needed to hold integrated organisations to account. He added commissioners would need to be very good "because you're setting up a powerful monopoly provider - you would have to have the skills and incentives to get this system to work properly".

Innovations in integration: proposed models

Integrated health and social care commissioning:

• Health and social care foundation trusts

• Integrated health and social care teams

• Individual patient budgets for long-term conditions - as proposed in several strategic health authority Darzi vision documents

Primary healthcare integration:

• Integrated commissioner and provider organisations

• Integrated provider functions based on practice-based commissioning

• Creating a primary care market with multiple integrated organisations delivering various aspects of care, such as disease-specific organisations.

Primary and secondary care integration:

• Practice-based commissioning consortia taking responsibility for entire health service budgets for their populations

• Stronger relationships between primary, community and specialist providers as an interim measure