Altogether now ? Policy options for integrating care

there are four main types of integration. These are: integration of GPs and other primary care professionals in the primary health care team; integration of the primary health care team with other health care professionals working in the community (e.g. district nurses, health visitors, allied health professionals and pharmacists); integration of the primary health care team, other health care professionals working in the community and social care professionals; and integration of the primary health care team, other health care professionals working in the community, social care professionals, and hospital-based specialists international evidence has highlighted the benefits of health and social care integration. Factors identified as important in the models that have been developed include: umbrella organisational structures to guide integration at strategic, managerial and service delivery levels; case-managed, multi-disciplinary team care, with a single point of contact and co-ordinated care packages; organised provider networks, with standardised referral procedures, service agreements, joint training and shared information systems etc.; and financial incentives to promote prevention, rehabilitation and the downward substitution of services in relation to primary health care integration, a review of international models carried out to inform developments in Canada identified four approaches: the integrated community model, the non-integrated community model, the professional contact model, and the professional co-ordination model. The review found that no single model met all criteria of effective primary health care but concluded that the integrated community model and the professional co-ordination model fulfilled most of the desired characteristics a review by the OECD of care coordination described a range of approaches adopted in different countries. These included care and case management, disease management and patient pathways. The review noted that primary care providers often had a key role in care co-ordination when patients were referred to hospital, while within hospitals co-ordination was usually handled by specialists. The OECD identified four areas where reforms could potentially enhance the capacity of health systems to better coordinate care: better information transfer and wider use of IT; increased resources going to ambulatory care; new primary care models based on multidisciplinary teams; and greater health system integration analysis of integrated delivery systems in the US has identified seven features of these systems: multispecialty group practice in which GPs and specialists work alongside each other to provide care; health care teams that make use of the skills of nurses, allied health professionals, pharmacists and others; defined populations that enable doctors and the wider health care team to develop a relationship over time with a ‘registered’ population; aligned financial and payment incentives, centred on prepaid group practice for doctors, that avoid the perverse effects of fee for service reimbursement and encourage the prudent use of resources; a medicinemanagement partnership that links the clinical skills of health care professionals and the management and organisational skills of executives; enhanced information management capability through the use of the electronic patient care record, and clinical decision support systems; and explicit accountability for performance to key stakeholders e.g. through public reporting of quality and outcome data Policy options for the NHS