The first primary care trust to unveil its plans for an integrated care pilot has warned that commissioners will have to overcome existing 'anomalies' to make the initiative work.
Surrey PCT's board agreed its integrated care pilot specification this month, meaning it can bid to host one of the pilots unveiled in health minister Lord Darzi's next stage review.
Surrey's proposal outlines a set of goals covering integration, outcome measurement, market creation and patient engagement (see list below).
Deputy chief executive Paul Bennett said the PCT was keen to be in the national programme but planned to run its pilot in any event.
But he said drawing up the proposals had raised questions of budget-setting for practice based commissioning, managing commissioning relationships between existing and new organisations, and even whether hard budgets for integrated care organisations should be considered.
"There are some anomalies that it's thrown up," Mr Bennett said "We need to maintain the integrity of the commissioning structure we've got. We're trying to take this as far as we can within existing practice based commissioning guidance. To go beyond that as integrated care organisations potentially requires some changes in policy."
The PCT's proposals come amid reports of huge interest in the integrated care scheme.
PCT Network director David Stout said the pilots would be a test of PCTs' approaches to commissioning as much as any new structure for provision of services. They should only take place in areas where PCTs had a broad integrated care commissioning strategy in place. He said: "You do need to be confident you know what you're doing, hence there won't be hundreds of pilots."
There was a need for financial support or "practical hands-on external capacity" from the DH, he said. "It's quite a big task on top of the day job."
NHS Alliance chair Michael Dixon predicted the number of applicants could be as high as 50. He said some were likely to focus on integrated solutions for particular conditions such as diabetes, while others would seek to take over entire health budgets.
Surrey's plans for an integrated care pilot
Measurably improve patient care, including health outcomes
Extensive patient engagement
Create pluralistic local market
Make more GP practices take greater responsibility for entire health budgets
Initiate integration of health and social care
Create efficiency gains compensating PCT for cost of pilots
Test and refine specification to enable PCT to commission ongoing services after pilots