Abstract
The introduction of the Integrated Care System (ICS) this year is likely to see primary and secondary care working more closely together (NHS England and NHS Improvement, 2020). The Clinical Commissioning Groups (CCGs) and the reforms of the Lansley era are likely to be replaced in the near future. As trainees it is helpful to be aware of the changes in our health landscape to understand where the socio-political shifts are moving.
Conceived in 2018 in an environment of increasingly disjointed care and the complex bureaucracy of commissioning, the ICS’s have been tasked to do exactly this: Integrate care. Some have already launched across the UK establishing their new roles and changing the way in which healthcare is implemented.
Their core message is simple – build partnerships between local government, NHS trusts and primary care (as well as tertiary sector) to deliver care at scale to populations supported by robust agreements between healthcare providers (NHS England and NHS Improvement, 2020). All this with government-backed legislation to ensure funding and nationwide role out (devolved of course). Finally, they intend to use and collect data to make sure the systems talk well with each other and ‘put the citizen at the heart of their own care’.
There remains a striking resemblance to the strategic health authorities (SHAs) of the previous NHS structure. One interesting aspect of the proposition of the ICS model is a return to the close inter-connectedness of local governments and healthcare while still retaining NHS England’s ‘overseer’ role.
With all this in mind it is likely that we will see a rise, as Lasserson (2017) writes, in the emerging ‘interface medicine’. Here the boundaries between primary and secondary care become more blurred. Undifferentiated illness remains the mainstay of general practice, but as our health systems change the decisions are reliant on being able to spot those who need admission and those who can remain in the community with specialist care reaching out of hospitals and into the community.
Throughout our training as Associates in Training (AiT) we are afforded a broad view of the NHS. We are some of the best placed people within the healthcare system to think creatively about new pathways of care for the betterment of our colleagues in primary or secondary care and, ultimately, our patients.
While legislation and funding provide one part of the story, the heart of the success or failure of the ICS model is the relationships that can be fostered between primary, secondary and social care as well as local government and tertiary services. The better we can communicate, share resources and workload, the more integrated our patients’ care will become.
