Peers look to reap the rewards of integrated primary and community healthcare services

A lack of co-ordination between the everyday primary and community services relied on by people using the NHS is leading to sub-standard care, missed opportunities for home or community-based treatments, and undue strain on hospitals that are already overstretched.

And there must be significant reform in terms of better staff training, improved data sharing, flexible healthcare structures, and collaboration across different professions in the healthcare system, according to a report published by the House of Lords Integration of Primary and Community Care Committee.

The proposed reforms will realise the potential of an integrated NHS and deliver more-efficient healthcare services, ensuring value for money and satisfied, healthier patients.

The report, entitled Patients at the centre: integrating primary and community care, highlights the need for a seamlessly-integrated, patient-centric healthcare sector where patients are given the type of care they need, when, where, and how they need it; whether that be access to a GP, a pharmacist, or a district or mental health nurse.

A focus on prevention

And there must be a focus on preventative rather than reactive care to tackle the needs of an aging population, many of them coping with complex health issues requiring intricate and continuous care.

Key conclusions and recommendations from the report include:

• The need for streamlined structures and organisation of NHS services. Integrated Care Systems (ICSs) are a good starting point for collaborative working, but their relationship with other healthcare bodies, public bodies, and local government must be based on mutual professional respect.The Department of Health and Social Care (DHSC) should evaluate ICS structures before implementing any major health service reforms
• There needs to be a more-simplified and flexible system for awarding contracts and allocating funds within the NHS to encourage multi-disciplinary, integrated working. DHSC and NHS England (NHSE) should reform the contract process and ensure new contracts are flexible in commissioning of primary care. The Government should also explore different ownership models for GP practices to facilitate more-joined-up and better care
• Data-sharing is crucial to successful healthcare integration. When patient information is stored on different systems, people can end up frustrated due to answering questions about their conditions and treatment repeatedly as they switch between services. A properly-maintained Single Patient Record (SPR) is an essential component in tackling this issue. Healthcare professionals should also be able to confidently share data across sectors to make it easier to provide joined-up care. DHSC should publish high-level guidance to standardise data collection, portability requirements, and clarify the concept of data sharing and privacy laws to ensure timely patient access to medical data
• Equipping staff to work across multiple clinical disciplines through improved training will make integration of services easier. Currently, staff spend more time meeting everyday demand, rather than implementing new integration strategies. Clinicians should be introduced to the work of other services through job rotations. Social care needs should also be included in the NHS’s Long Term Workforce Plan to ensure that enough well-trained social carers are available.

Commenting on the report, Baroness Pitkeathley, committee chair, said: “For most people the NHS does not mean hospital care, but their GP practice and/or community care. But lack of co-ordination between these everyday services means patients are receiving sub-standard care and missing out on many services which could help them by ensuring they receive treatment in their own homes or community, without putting extra strain on beleaguered hospitals.

A lack of understanding

“An occupational therapist can fix a handle in your bathroom to ensure you don’t fall, while a community physiotherapist can keep you active enough to avoid a knee operation.

“However, a lack of understanding of the importance of such services, poor communication between the service providers, and badly-co-ordinated care means wasted NHS resources and frustration for patients.

“We need more-joined-up care, and more focus on preventative services if the NHS is going to be able to address the problems posed by the growing number of people in our society with multiple health issues which need complex and continuous care.

“It is not an impossible task, but requires, as our report sets out, more-flexible systems, better data sharing, shared training of staff, good leadership, and mutual respect between the many different professions in the system.

“The reward will be better value for money, a more-efficient system, and, above all, better outcomes for patients.”