Clinical commissioning groups will find it no easier than primary care trusts to provide integrated care unless they are able to overcome perverse incentives, a report has found.

A joint study published today by the Nuffield Trust and the King’s Fund, Commissioning Integrated Care in a Liberated NHS, says policies emphasising patient choice and meeting performance targets over collaboration, as well as the payment by results system, have hampered integration.

Judith Smith, head of policy at the Nuffield Trust, who co-authored the report, told HSJ that integrated primary and secondary care services were “almost operating beneath the radar of the mainstream NHS”.

She said economies of scale in developing integrated services could be achieved if the NHS Commissioning Board provides guidance and support for CCGs, rather than leaving them to develop in isolation.

The report also said: “There may be a need to revisit the split between commissioners and providers, so innovative commissioners can make as well as buy services… eventually patients might choose between competing but clinically integrated networks.”

The recommendations come as NHS chief executive Sir David Nicholson hailed a drop in admissions as evidence that CCGs are driving better care. General and acute non-elective admissions in the first quarter of 2011-12 were down 2.5 per cent from the same period a year earlier. GP referrals fell by 4.1 per cent.

At a National Association of Primary Care and NHS Alliance conference last week, Sir David said: “That’s never really happened before [and] potentially shows the power of the work that [clinical commissioners] are starting to do.”