interviews

Bridging the divide between primary and secondary care

Chris Hopson, chief executive of the Foundation Trust Network, and Rick Stern, chief executive of the NHS Alliance, discuss how the two organisations have collaborated in an effort explore what ‘optimally’ integrated care could look like in the future. David Stevenson reports.

NHS England boss Simon Stevens recently stated that it is “perfectly possible” to improve and sustain the NHS over the next five years in a way that the public and patients want. But to secure that future the NHS needs to change substantially.

At the launch of the ‘Five Year Forward View’ he highlighted a number of actions that need to be taken. These include the need to break down the boundaries between family doctors and hospitals, between physical and mental health and between health and social care.

Stevens noted that the Forward View is not a blueprint for care throughout the entire country, adding: “England is too big for a one-size-fits-all plan, and nor is the answer to simply let ‘a thousand flowers bloom’. It’s horses for courses.”

This is also the view taken by the Foundation Trust Network [soon to be NHS Providers] and NHS Alliance, which partnered to explore how new models of integrated care can be delivered – bridging the artificial divide between primary and secondary care.

The two national organisations aim to bring together senior leaders from primary care and secondary care to discuss difficult challenges and identify shared solutions. They also aim to facilitate the sharing of good practice particularly showcasing case studies where colleagues from across the divide are working closely together to improve communication between professionals, and streamline pathways for patients.

Holding up the mirror

Chris Hopson, chief executive of the FTN, told NHE: “One of the key leaps forward, which both our organisations agree very strongly on, is that integrated care really is important and that it is about local people making decisions about what the best local model for them is.

“At the moment there is a bit of a ‘strategic ferment’ in terms of people really thinking about the challenges of integration. People know that the existing model, in the long-term, won’t work, and we know we need to do something different, but we’re not quite sure  what.

“One of the clever things we can do, as national organisations, is to hold up the mirror to various places that are perhaps slightly more advanced in answering the questions of how might we do this. There is some really interesting stuff going on but across healthcare we’re not very good at playing that back to people and enabling them to pick up on the experience that is being developed elsewhere.”

In symphony

FTN and NHS Alliance are due to release their first report, which will highlight examples of best practice and how some primary and secondary care providers are getting “braver” and more “creative” in how they intend to deliver integrated care.

One such example is the Symphony Project, an innovative, evidence-based integrated care programme which aims to improve the way in which health and social care is delivered in South Somerset.

Symphony’s aim is to establish much greater collaboration between primary, community, acute and social care, particularly for people with complex conditions.

There is a well-established Symphony Board including Somerset CCG, Somerset County Council, Somerset Partnership NHS Foundation Trust, Yeovil District Hospital NHS Foundation Trust and others, chaired by a GP on the CCG’s governing body.

All the partners have contributed £27,000 to a shared project budget and by using an alliance contracting model they aim to spread the risk and share any gains between all providers. The initial plans are to start small, focusing on a cohort of the sickest patients within South Somerset (population 164,000), but the ambitions are to roll it out across the county.

Rick Stern, chief executive of the NHS Alliance, said: “We’ve been looking for examples of good practice where people are working really effectively across the system and we’re going to pull some of that together in our upcoming paper which will express, in more detail, how we think we can help support the system in better ways by having joined-up conversations.”

After hosting a number  of working sessions earlier this year, both chief executives stated that it was interesting to see that when clinicians were put together in the same room as GPs, consultants, nurses and other health professionals how quickly a common view could be reached on what people would like to do.

“It is then a big management challenge to ensure that we make the system support what we want to deliver as better care in the future,” said Stern. “The most important imperative in the health service is that we start being a lot braver at how we work together and how we do things that are good for patients, rather than things which support the individual interests of professions or organisations.”

Getting primary care right

Both Hopson and Stern added that there are lots of different ways that barriers can start to be broken down. They also discussed the various care models suggested in the recent Five Year Forward View.

For example, they noted how important the new primary and acute care systems, which combine for the first time general practice and hospital services, similar to the accountable care organisations now developing in other countries too, could be.

Hopson said: “I’m incredibly struck how over the last year how many members of the FTN have said ‘we can’t do our job properly unless we get the relationship with primary care right’. There is a real sense that primary care, in its broadest sense, is such a key part of local healthcare provision. But unless we can get the join-up right it really doesn’t work.

“You only have to look at some of the international examples, such as accountable care organisations in the USA, where people have been able to not only provide much better outcomes for patients, but a better experience for the workforce and provide care more effectively and efficiently when people have done that ‘vertical integration’.”

During the interview with NHE, the partners stated that any changes in the future should not be about how hospitals can take over primary care or how general practice can ensure that hospitals can do what they want, but it is about how the different parts of the system can come together in new and creative ways.

They added that the conversations around integrated care are getting ‘increasingly joined-up’, but turning it into practical reality is always much harder.

Breaking down historic interests

Stern noted, however, that the partnerships and the conversations being had “offer a real sense that it’s possible to do things in a different way”.

He added that, traditionally, primary and secondary care have been positioned as having very different interests, “but as soon as we started talking to each other it was clear that we had common values and collectively we’re all looking to improve care and address some of the major pressures on the system”.

It was suggested that there should be some national level involvement about what the overall direction of travel might be with regards to integration.

“But we feel very strongly that the Five Year Forward View, which looks at a number of different ways of bringing services together, is a step in the right direction,” said Hopson. “A one-size-fits-all approach won’t work, but equally there won’t be a thousand ways of doing this. What is great to see is the ambition that it is really up to the local health and social care economies to identify which route they wish to go down and pursue.”

FTN and NHS Alliance will collaborate over the next six months and continue gathering, discussing and communicating how primary and secondary care providers can deliver better integrated care. Although a fixed timetable is not set, Stern said: “I imagine our members on both sides will have a number of thoughts, but if at the end of our work we can come up with something useful to support and encourage the debate whether nationally or locally then that would be great.”

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