Many primary and community care managers are designing ineffective and inefficient services for people with long term conditions, a senior Department of Health adviser has said.

GP Sir John Oldham, lead for the long term conditions and urgent care elements of the quality, innovation, productivity and prevention programme, told HSJ services for specific diseases were being designed in isolation. The DH says services should be designed for most patients who have multiple long term conditions and focus on preventing hospital admissions.

But Sir John said managers were still employing specialist clinicians, particularly community nurses, for some conditions.

“The majority of people who have unscheduled admissions have two or three conditions, and this is the big issue that faces us,” Sir John said.

Sir John said few local service managers were “making the order of change that they need to” given the aging population.

Meanwhile, the DH has confirmed QIPP, led by national director for quality and efficiency Jim Easton, is keeping its name. Health secretary Andrew Lansley appears to be backing the programme, calling QIPP a way of “driving quality and quality improvement” in a recent speech.