Intended for healthcare professionals


Divided views rule implementation of integrated care

BMJ 2018; 361 doi: (Published 13 April 2018) Cite this as: BMJ 2018;361:k1620
  1. Jennifer Richardson, features editor
  1. The BMJ, London, UK
  1. jrichardson{at}

Disagreements over how best to achieve the common goal of more joined up services were revealed at a debate on the latest proposed vehicle, reports Jennifer Richardson

“I struggle to find anyone that argues we want disintegrated care,” said Paul Maubach, chief executive officer for Dudley and Walsall clinical commissioning groups, at an event held by the King’s Fund think tank on 21 March.1

The principle of integrated care is not in question. What there is fundamental disagreement over is how best to help commissioners, providers, professionals, and patients work collaboratively to achieve health outcomes and make most effective use of resources across health and social care. The mechanism for integrated care—and, in particular, the proposed use of accountable care organisations (ACOs, see box)—is very much in question.

Under government plans, ACOs will be single organisations that local commissioners contract to deliver all services to a defined population, including through subcontracting. The government has sought to play down their importance by describing them as “just one of the ways” the NHS is working towards “ending the fragmented way that care has been provided to improve services for patients,” and stressing that they are “not a new type of legal entity and so would not affect the commissioning structure of the NHS.”2

Yet ACO contracts have caused consternation, with some people seeing them …

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