Feature Integrated Care

Integration of services or empire building?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1854 (Published 06 March 2014) Cite this as: BMJ 2014;348:g1854
  1. Gareth Iacobucci, news reporter
  1. 1BMJ, London WC1H 9JR, UK
  1. giacobucci{at}bmj.com

Although most general practitioners support integrated care, they are wary of losing their independence as hospital trusts attempt to take over primary care. Gareth Iacobucci looks at how one ambitious trust in Newcastle is trying to win them round

The integrated care bandwagon has been steadily gaining traction in the NHS in recent years. Politicians, clinical leaders, and academics are queuing up to hail the supposed saviour of the UK health service, which is claimed to deliver the holy grail of improved care and long term financial sustainability.1 2 3

If implemented effectively, it is difficult to argue that collaborative working between primary, secondary, community, and social care will not benefit patients and improve efficiency. But in a health service rife with factionalism, projects are often derailed by disagreements over the definition of integrated care, how it should be delivered, and who should lead it.

In primary care, the term “integration” is often viewed suspiciously as a euphemism for a hostile takeover by large, powerful hospital trusts. Some general practitioners fear that integrated care may lead to the end of their independent contractor status and remove their autonomy by making them employees of hospital trusts.

Clare Gerada, former chair of the Royal College of General Practitioners, argues that GPs must take the lead if integration is to succeed,4 as they have the will to shift more care out of hospitals and into the community. This, after all, is the stated political aim of all major political parties, conscious of an ageing population with more complex and costly health needs that needs to be treated closer to their homes.

But hospital trusts such as Newcastle upon Tyne Hospitals NHS Foundation Trust in the north east of England—consistently rated as one of the UK’s top trusts and member of the …

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