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Clinically integrated systems: the future of NHS reform in England?

BMJ 2011; 342 doi: (Published 28 March 2011) Cite this as: BMJ 2011;342:d905
  1. Chris Ham, chief executive1,
  2. Jennifer Dixon, director2,
  3. Cyril Chantler, chairman3
  1. 1King’s Fund, London W1G 0AN, UK
  2. 2Nuffield Trust, London
  3. 3UCL Partners, London
  1. Correspondence to: C Ham c.ham{at}

Recent reforms to the NHS in England seem to make integration of care harder rather than easier. But Chris Ham, Jennifer Dixon, and Cyril Chantler argue that integration is not incompatible with competition and that it is essential for more efficient care

A recent survey of 1000 general practitioners and hospital doctors in England found that they thought increased collaboration between clinicians and better coordination between organisations were the best ways for the National Health Service to achieve efficiency savings.1 The results underline the potential for clinicians and organisations to work together to enable the NHS in England to make the £20bn (€24bn; $32bn) of efficiency savings that it has been challenged to find. Working together means clinicians and organisations overcoming the fragmentation that results in “deficiencies in timeliness, quality, safety, efficiency and patient-centredness” by developing integrated models of care.2

We argue that general practice commissioning should be used as a platform on which to build integrated care in the NHS in England. There is no inherent contradiction between the government’s wish to increase patient choice and provider competition on the one hand and the argument for greater integration on the other. Effort should therefore focus on developing choice between competing clinically integrated systems.

What is integrated care?

Integrated care takes many different forms. In some circumstances, integration may focus on primary and secondary care, and in others it may involve health and social care. A distinction can be made between real integration, in which organisations merge their services, and virtual integration, in which providers work together through networks and alliances.3

Integration may also entail bringing together responsibility for commissioning and provision. This form of integration is important because it allows clinicians to use budgets to either provide more services directly or commission these services from others. Integrating commissioning …

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