A lack of coordination 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. 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. These reforms will realise
the potential of an integrated NHS and deliver more efficient
healthcare services ensuring value for money and satisfied,
healthier patients. This is the major conclusion of a report
published today from the House of Lords Integration of Primary
and Community Care Committee.
The report, 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. 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 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 , Chair of the
Integration of Primary and Community Care Committee,
said:
“For most people the NHS does not mean hospital care but
their GP practice [Primary Care] and/or Community Care [district
nurses/pharmacists/mental health nurses]. Lack of coordination
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.
“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 coordinated
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.”
