Primary care trusts may need to find new methods of protecting patient choice if integrated care organisations become monopoly healthcare providers.

The Department of Health last week invited applications for around 20 pilot integrated care organisations. Various forms of provider, including GP groups, acute trusts, foundation trusts, PCT provider arms and care trusts, are expected to work closely or merge into the new bodies.

This may result in monopoly providers in certain areas. GPs could work with specific providers, raising questions about whether patients would have genuine choice.

The prospectus for these organisations acknowledges the pilots may "present particular issues for system management and competition".

Improved outcomes

The DH would consider waiving competition rules "but only if the scheme is radical and demonstrates real potential to improve outcomes", it said. The co-operation and competition panel would also have to agree.

PCT Network director David Stout said: "If you are employing GPs and hospital services together, how can you be sure you are offering a real choice?" He also said new ways of monitoring and enforcing choice may need to be found. "That might need to be slightly more than what we have currently. That is part of the pilots. You are testing the people commissioning it [as well as the new organisations]."

NHS director general for commissioning and system management Mark Britnell told the NHS Alliance annual conference last week the pilots were a big opportunity for primary care providers: "You will lead the national debate because ICOs will be based around practice lists."

The DH is also looking at introducing further integrated care pilots, led regionally.

Protecting choice

NHS Alliance chair Michael Dixon said he believed choice would be protected, and integrated care would help ensure a variety of good services.

Oliver Bernath, managing director of integrated care consultants Integrated Health Partners, said the prospectus laid the way for independent and strong new models.

In particular he welcomed its reference to an organisation being paid a risk-adjusted capitation sum for its registered patients, he said.

Birmingham University professor of health policy and management Chris Ham said he believed there would be significantly more than 20 applicants.

"I hope the department will support the pilots which will be more ambitious rather than less," he said.


  • Reduced uptake of emergency care

  • Patients given information to be involved in decisions about their own care

  • Personal care plans

  • Uptake of services among hard to reach groups

  • Patient satisfaction on choice, dignity and "timely and seamless care"

  • Reduction in average cost per patient per practice

  • Reduction in delayed discharges

  • Social care record to contain NHS number

  • Evidence of quality improvement systems

  • Incentive schemes to shift care into the community and empower patients