The way that healthcare is delivered is changing; increasingly care will be provided in networks that facilitate services closer to home, and outside hospital whenever possible. The RCP argues that in the light of changes in the way that healthcare is delivered, integrated systems, clinical leadership in commissioning and aligned incentives will be essential to providing the best care for patients.
To begin to achieve this vision and provide the best care for patients, we believe that three conditions must be in place:
- Integrated systems - Integrated models of care, in which multi-professional teams and patients work together in a managed network across traditional interfaces, can deliver care that is closer to home.
- Clinical leadership in commissioning - Good commissioning depends on the ability to respond to the health needs of the local population and design and deliver high-quality care for patients. In the context of rising comorbidity (the presence of additional disease(s) or disorder(s) alongside a primary disease/disorder) and an ageing population with increasingly complex needs, it is essential to agree commissioning frameworks that are based on good information-sharing and recognition of the contributions of clinical teams.
- Aligned incentives - Under the current tariff-based system, hospitals are encouraged to treat more patients, while (GPs) are encouraged to refer fewer patients into secondary care. This tension can work against the development of integrated services that provide the best quality of care. It is crucial that we rebalance the disincentives to ensure that both high-quality generalist and specialist care have a sustainable future for the benefit of patients.
These conditions must be underpinned by patient involvement in the development of future commissioning systems, particularly in the case of patients with long-term conditions.
