A Lords Committee has warned that a lack of coordination between primary and community services is leading to sub-standard care, missed opportunities for home or community-based treatments, and undue strain on hospitals that are already overstretched.
The Committee says that 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 the report titled: 'Patients at the centre: integrating primary and community care'.
The Committee's report 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. The Committee says that the government should focus more on preventative rather than reactive care to tackle the needs of an ageing population, many of whom are coping with complex health issues requiring intricate and continuous care.
Key recommendations within the report include:
- Structures and organisation of NHS services need to be streamlined. 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 the commissioning of primary care. The Government should explore different ownership models for GP practices to facilitate more joined-up and better care.
- Efficient data-sharing is crucial to successful healthcare integration. Fragmented systems often require patients to repeatedly provide the same medical information, causing frustration. A properly maintained Single Patient Record (SPR) and the ability for intersectoral data-sharing between healthcare professionals are essential to tackle this issue. The DHSC must issue guidance to standardise data practices and clarify data sharing within 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.
Baroness Pitkeathley, Chair of the Integration of the 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.”
