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O'Dowd's well presented piece highlights some major problems in the present approach being undertaken to manage primary care service delivery. The move to integrated primary care will be seen by many as laudible, and the model being delivered by Steve Kell and his colleagues sounds of real interest. But the history of the NHS is peppered with futile, misguided plans which fail because of the lack of evidence to support or refute the initiative. How do we know that integrated IT and phone systems will actually help facilitate collaborative working?. The three aims presented represent excellent ambitions - but how do we know that these are being achieved? How do we know whether money is saved or lost around the initiative, and where is the evidence that such models - superficially worthy in their own right, and often with intuitive appeal - are in any sense 'optimal'? Simple questions, but caution is required in providing a defensible answer.
Major initiatives like this need careful evaluation, and, if the NHS is to benefit from the exercise, real money and careful planning of a suitable research programme to parallel the initiative are essential at the very earliest stages of considering possible changes in models of care. Researchers in the UK have the expertise to undertake such valuable work for the NHS, but major blocks in the system need addressed - and quickly. The country cannot afford the present profligate research cycle where researchers face near-insurmountable obstructions, sometimes lasting years, in securing the necessary finance and permissions to plan, deliver, and report the research. By the time the evidence is available, the question has often changed, and the model refocussed on the next cycle of service change. Much more streamlined research systems need to be ensured by the NHS and it's research wing, the National Institute for Health Research (NIHR). We have the skills, interest, and ability to provide the evidence, but until much more careful coordination exists between the NHS and the NIHR, none of us are ever likely to be able to say with any degree of confidence whether the work undertaken in Larwood and Bawtry should be replicated elsewhere, what might be the drivers to successful change, or whether the new model might actually worsen the challenges already faced by primary care health professionals.
Competing interests:
No competing interests
01 June 2016
John L Campbell
Professor of General Practice and Primary Care
University of Exeter Medical School
Smeall Building, St Lukes Campus, Magdalen Road, Exeter EX1 2LU
Re: Home run for integrated primary care?
O'Dowd's well presented piece highlights some major problems in the present approach being undertaken to manage primary care service delivery. The move to integrated primary care will be seen by many as laudible, and the model being delivered by Steve Kell and his colleagues sounds of real interest. But the history of the NHS is peppered with futile, misguided plans which fail because of the lack of evidence to support or refute the initiative. How do we know that integrated IT and phone systems will actually help facilitate collaborative working?. The three aims presented represent excellent ambitions - but how do we know that these are being achieved? How do we know whether money is saved or lost around the initiative, and where is the evidence that such models - superficially worthy in their own right, and often with intuitive appeal - are in any sense 'optimal'? Simple questions, but caution is required in providing a defensible answer.
Major initiatives like this need careful evaluation, and, if the NHS is to benefit from the exercise, real money and careful planning of a suitable research programme to parallel the initiative are essential at the very earliest stages of considering possible changes in models of care. Researchers in the UK have the expertise to undertake such valuable work for the NHS, but major blocks in the system need addressed - and quickly. The country cannot afford the present profligate research cycle where researchers face near-insurmountable obstructions, sometimes lasting years, in securing the necessary finance and permissions to plan, deliver, and report the research. By the time the evidence is available, the question has often changed, and the model refocussed on the next cycle of service change. Much more streamlined research systems need to be ensured by the NHS and it's research wing, the National Institute for Health Research (NIHR). We have the skills, interest, and ability to provide the evidence, but until much more careful coordination exists between the NHS and the NIHR, none of us are ever likely to be able to say with any degree of confidence whether the work undertaken in Larwood and Bawtry should be replicated elsewhere, what might be the drivers to successful change, or whether the new model might actually worsen the challenges already faced by primary care health professionals.
Competing interests: No competing interests