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Letters Home run for integrated primary care?

Lack of evidence hinders integrated primary care

BMJ 2016; 353 doi: (Published 14 June 2016) Cite this as: BMJ 2016;353:i3266
  1. John L Campbell, professor of general practice and primary care
  1. University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK
  1. john.campbell{at}

O’Dowd’s piece on the move to integrated primary care will be seen by many as laudable,1 but the NHS’s history is peppered with plans that fail because of a lack of evidence.

The three aims represent excellent ambitions, but how do we know that these are being achieved? To what extent do integrated IT and phone systems really help collaborative working? Is money saved—or lost—around the initiative, and where is the evidence that such models are “optimal”? These simple questions require caution in providing a defensible answer.

Such major initiatives need careful evaluation. UK researchers have the skills to undertake such work for the NHS, but major blocks in the system must be tackled—and quickly. The country cannot afford the present profligate cycle where researchers face obstructions, sometimes lasting years, in securing the finance and permissions to plan, deliver, and report research. By the time the evidence is available, the question has often changed.

We have the skills, interest, and ability to provide the evidence, but, until careful coordination exists between the NHS and the National Institute for Health Research to provide streamlined research systems, we’re unlikely ever to say with confidence whether the work undertaken in the Larwood and Bawtry area should be replicated elsewhere, or what might drive successful change, or whether the new model might actually worsen the challenges already facing primary care professionals.



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