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NHS policy hampers integrated care commissioning

NHS policies aimed at outdated goals impede effective commissioning

Louise Prime

Thursday, 22 September 2011

Commissioners in the emerging clinical commissioning groups will struggle to make services more integrated and efficient unless Government support for commissioning increases and outdated NHS policies are revised, warn experts.

Local commissioners in PCTs have often been impeded from making radical reforms in order to solve current problems – such as the need for integrated care for patients with long-term conditions – by aspects of NHS policy that were originally designed to meet goals such as cutting long hospital waiting lists and waiting times for elective care, they claim in a report out today.

The authors of Commissioning Integrated Care in a Liberated NHS, Dr Judith Smith from the Nuffield Trust and Professor Chris Ham from The King’s Fund, warn that these issues must be tackled, and Government support for commissioners increased, if the new commissioning groups are to succeed.

Dr Smith argues: “The drive to cut waiting times for planned care through competition has inadvertently put barriers in the way of developing services that would improve care for people living with complex long-term conditions, and those who need intensive support at the end of their lives.”

She and Professor Ham recommend that new approaches to commissioning should be explored, including revisiting the commissioner-provider split, “with groups of GPs and specialists given a budget to plan and deliver more integrated care for their local communities.”

“If the new generation of clinical commissioners is to do better than their PCT forbears, the Government will need to craft an environment in which hospitals and GPs are encouraged to work collectively to shape new forms of high-quality care for a particular population and face greater penalties for failing to do so,” said Dr Smith.

Professor Ham insisted that both competition and integration should be supported by Monitor and the NHS Commissioning Board.

He also called for a revision of the outdated way in which incentives are used: “Payment by results was designed primarily to support choice and competition in relation to elective care at a time when the NHS budget was growing significantly. Alternative forms of payment are required to support integrated care, especially for people with chronic diseases and to support more coordinated unplanned care, when funding is very tight.”

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